Yes	No
1.	Are you a California resident?

2.	Are you or your children a U.S. citizen or a Legal Permanent Resident?
3.	Are you under 60 years old and not permanently disabled?
4.	Is the sum total of your household's cash on hand, bank accounts, retirement accounts, etc. less than or equal to $2000?
5.	Is your household's gross monthly income within the limits below? (Gross income is the amount of money earned before taxes)

If you answered yes to the above questions you may be eligible for Food Stamps,

Note: California residents that are in receipt of SSI/SSP are not eligible to receive Food Stamps. However, family members may be eligible.

If you would like assistance applying for Food Stamps, please complete the following information and click ‘submit'. We will contact you.

Name:

Street Address :

City: Zip:

Telephone: