SNAP Application Assistance Form
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Email *
This form is for individuals who would like to apply for SNAP/EBT (food stamps) benefits. If you currently receive SNAP benefits, please do not fill this form.
This form asks questions regarding your gender, ethnicity, and geographic region for data purposes only. Please provide consent that we can use your information for data collection. We will not share your information with any third-parties. *
How did you hear about us? *
Please provide your Full Name (First, Middle, Last) *
What is the best phone number to reach you? *
Please provide your email address. *
What is your Date of Birth? *
What best describes your gender? *
What is your current immigration status? *
Are you Hispanic or Latino? *
Regardless of your answer to the previous question, please indicate how you identify yourself. *
Which Massachusetts county are you located in? *
Do you have any questions/ concerns about the SNAP application process?
Jump Start staff will be in touch with you within 24-48hrs. 
For further assistance, feel free to contact us at snap@hcc.edu
A copy of your responses will be emailed to the address you provided.
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