Program Forms

*All forms also available for download within the application portal.*

The Income Self-Certification is required if an applicant is not providing a 2020 1040, documentation of other state or federal benefits, or documentation of all household income for the past 30 days.

Income Self-Certification Form (English)

Income Self-Certification Form (Spanish)

The COVID-19 Hardship Self-Certification is available for e-signature within the application portal, towards the end of the list on the Documents tab. A .pdf of the signed form will be created and uploaded to the application. If the blank .pdf is needed, it is below.

COVID-19 Hardship Self-Certification Form (English)

COVID-19 Hardship Self-Certification Form (Spanish)