Long Beach Pledge Application Feedback

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We are always working to improve our application process. If you encountered any difficulties or confusion while filling out your form please tell us about it below.

What section of the application did your issue take place?

Part One: Applicant Informaiton

Part Two: Your Household

Part Three: Household Benefits

Part Four: Upload Documents

Document 1: Proof of Address

Document 2: Proof of Income

Final Review

Not Sure

Other:

Please describe your issue in as much detail as possible. (For example, "In Part One: Applicant Information, the application asked me which email I use, but for some reason, it won't accept my email address.")

Is there anything else we should know about your experience filling out this application?

What is your phone number or email in case we need to reach you? *

What is your name? (Optional)

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