Before next appointment
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***I verify that the information provided on this form is true and correct. Providing false information for the purpose of inappropriately obtaining TANF or SNAP E&T benefits may result in civil, criminal, or administrative penalties***
By checking the "I agree" box below, you agree and acknowledge that: your application will not be signed in the sense of a traditional paper document, by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, you may still be required to provide a traditional signature at a later date.
Auxiliary aids and services are available upon request to individuals with disabilities. Relay: 1-800-735-2989 (TTY) / 711 (Voice).
These services are funded in whole or in part with federal funds. More detailed information is located on the Board’s website.
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