SCN Food Support Application

Full name of the main applicant

This can be any adult in the household.

Date of birth

Medicaid / Insurance ID

Usually 2 letters, 5 numbers, 1 letter — for example XY67890Z.

Best phone number

Backup phone number

Another number we can try if your main phone is unavailable.

Home address

Please include apartment or unit number, city, and ZIP code.

How many people live in your home, including you?

A larger household can mean a larger food benefit if you qualify.

Who in the household does this apply to?

Share the name (or names) so we know who to reference.

Are you currently working?

Is anyone else in your home working?

Do you currently get SNAP (food stamps)?

Do you currently get WIC?

Do you receive any cash assistance?

Any food allergies, diabetes, or health conditions that affect what you eat?

If yes, please share details so we can plan the right food for you.

By submitting, you're letting our team reach out to review your application. Your information stays confidential.

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