Yes
No
SNAP
Medical Assistance
Child Care Assistance
Cash Assistance
*
*
Yes
No
Yes - Homeless
*
*
*
*
*
*
-
*
-
-
-
Draw
Type
Upload
Choose your signature image
*
*
*
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Active Duty
National Guard/Reserves
Yes
No
Yes
Yes
No
Yes
Yes
No
Yes
No
Yes
No
Yes
No
*
Yes
No
Yes
No
*
*
*
*
*
*
-
*
-
-
Yes
No
Yes
No
Yes
No
Yes
No
*
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No