SNAP Application — LCHI SNAP

Apply for SNAP

Please fill out the form below with the required information to apply for SNAP benefits.

View income guidelines for eligibility guidance.
Download and fill out the Permission to Share Information (PSI) form:
- PSI Form English
- PSI Form Spanish
Gather proof of income, expenses, residence and citizenship status.

LCHI SNAP Application

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First Name *

Middle Name

Last Name *

Suffix

Ethnicity *

Race

Preferred Language

Sex *

Date of birth *

Social Security Number *

Are you a U.S. Citizen? *

Yes

Phone *

Email *

Are You Homeless? *

Yes

Address *

Address

City

State/Province

Zip/Postal

Mailing Address

City

State/Province

Zip/Postal

Upload Completed PSI Form *

Required upload size: 5MB

Download, fill out and upload the Permission to Share Information file to continue with your application.

If you are human, leave this field blank.