EBBP Internal Form The information supplied below must match EXACTLY how you applied for the EBBP or Lifeline Credits. First Name * Last Name * Email Address * Phone Number * Application ID * Benefit Program * Lifeline through AdamsLifeline through another providerNot a Lifeline recipient Other Provider * How do you qualify? * Receives benefits under the free and reduced-price school lunch program or the school breakfast program, including through the USDA Community Eligibility Provision, or did so in the 2019-2020 school yearReceived a Federal Pell Grant during the current award yearExperienced a substantial loss of income since February 29, 2020 and the household had a total income in 2020 below $99,000 for single filers and $198,000 for joint filersMedicaidOther How do you qualify? – Other Description * Street Name * City * State * IL Zip Code * Benefit Qualifying Person – First Name * Benefit Qualifying Person – Last Name * Benefit Qualifying Person – DOB * Benefit Qualifying Person – Last 4 of Social Security # * Adams – Rep Name * Submit Δ
