You MAY QUALIFY for FREE Cell Phone Service

Please fill out this form to see if you qualify for the Free Cell Phone Service program.

Participating Networks: T-Mobile, Sprint, and AT&T only. $0 per month for Unlimited Talk, Text, and 7GB of LTE data.

If you qualify, a team member will let you know by Text and/or Call and will schedule your Activation Appointment.

Name

First Name

Last Name

Phone

(###)

###

####

Is this number OK to Text?

Do you have any of the following?

One or more of the following are qualifying criteria for the program:

Supplemental Nutrition Assistance Program (SNAP or “Food Stamps”)

Medicaid

Supplemental Security Income (SSI from Social Security)

Federal Public Housing Assistance (FPHA or “Section 8”)

Veterans Pension or Survivors

Federal Pell Grant for CURRENT award year

Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC)

Total Personal Income AT OR BELOW $2,265 per MONTH

Medicare Parts A and B, but NOT Part C or D

How much is your current phone bill per month?

How many people are in your Taxable Household?

Your best guess is fine — if you don’t pay taxes due to your income please list 1