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SEBT Application Form
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1. Get Started!
2. Household Programs
3. Adults
4. Adult Incomes
5. Students
6. Student Incomes
7. Other Children
8. Child Incomes
9. Final Summary
1. Let's Get Started!
Enter the name of the adult household member completing the application.
First Name
*
*
Middle Name
*
Last Name
*
*
Suffix (e.g. Jr., Sr., I, II, III)
*
Race
Ethnicity
Hispanic or Latino
Non Hispanic or Latino
Contact Preference
Preferred Contact Method
Phone
Email
Physical Letter
Preferred Contact Language
English
Spanish
Portuguese
Other
Other Preferred Contact Language
*
Please enter your contact information so that we can reach you in case there are any issues with your application.
Street Address 1
*
*
Street Address 2
*
City
*
*
Zip Code
*
*
State
*
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Phone Number
*
*
Email
*
*
Acknowledgement
I acknowledge that by selecting 'Yes', I am agreeing to only provide accurate and truthful information, and that I understand that the application will only be submitted when all sections of the form have been completed.
*
I acknowledge that by selecting 'Yes', I am agreeing to only provide accurate and truthful information, and that I understand that the application will only be submitted when all sections of the form have been completed.
No
I acknowledge that by selecting 'Yes', I am agreeing to only provide accurate and truthful information, and that I understand that the application will only be submitted when all sections of the form have been completed.
Yes
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