Please complete and return this application quickly.
(Or call us, and we will come and get it or help you with it!)
They need for you to include copies to verify:
All your income since January 1, 2010 (example: pay stubs, W-2, income tax return, child support, disability, unemployment, Social Security/SSI, TANF/OWF, self employment income, and any other income)
Your child's immunization record
Foster Care Status, if any
Birth certificate (can also use hospital certificate).
If you send an original, they will copy it and return it to you..
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