Center Card Application 2021 - temp form Header Image

Welcome and thank you for applying for a Center Card online!
We appreciate your assistance in streamlining our application process.

NOTE: If you already have a purple Center Card, please do not complete this online form unless you need to update the information on your account.


All communications about your Center Card application will be conducted via email. You must have an active, valid email address to complete an application.
Free email addresses are available at a variety of providers, including but not limited to gmail.com, outlook.live.com, mail.yahoo.com.

This application may take 5 to 10 minutes. Be sure you have adequate time and access to the internet to complete the entire process.
If you need a computer or internet access, call the Center at 402.476.4357 for assistance.

Make sure you list all of the children in your household, age 18 or younger, for whom you have primary legal custody/guardianship. You may not receive services for children not included on your application.

REMEMBER

The full application form may take 5 to 10 minutes to complete. Please be sure you have the necessary time and access to the internet to complete the entire process. List all children, age 18 and younger, for whom you have primary, legal custody/guardianship. Remember, you may not receive services for children not included on your application.

NOTE: If you already have a purple Center Card or completed a paper application at the Center, you do not need to complete this online application.

Each Center Card application may include up to two adults, you and your spouse/partner, and all of your minor children. Minor children includes anyone age 18 and younger, for which you and/or your spouse/partner have primary legal custody/guardianship. Any additional adults living at your address age 19 or older, even if they are your children, must apply for their own Center Card to access services.


By completing this application, I consent and agree to the entire Statement of Understanding.

STATEMENT OF UNDERSTANDING

  • All communications about my  Center Card application will be sent to the email address provided in my application, and I agree to provide an active, valid email address.
  • Submission of this application does not guarantee access to Center services. I must be income-eligible to receive a Center Card and services at the Center for People in Need.
  • I agree to provide:
    • true and accurate information regarding my family income, address and date of birth for myself, my Spouse/Partner and any minors/children (age 18 or younger) in the household;
    • updated information for annual renewal or replacement of a lost/stolen Center Card.
  • My Center Card must be renewed before its expiration date, and the renewal process could take 5 to 10 business days.
  • I and my spouse/partner will share access and limitations to Center services.
  • I cannot receive services from the Center without showing a current, valid Center Card.

Head of Household Information

Complete this section with your information only. Additional individuals in the household may be added later in the application process.

Name*
Have you used any other names?*
This could include maiden names, former married names, etc.
Date of Birth*
Do you have a Center Card?
Are you or your spouse/partner enrolled in the Center's POP scholarship program at SCC?
Gender*
You’ll receive updates related to the Center for People in Need at this email address. You can unsubscribe at any time by clicking the "update your preferences" link in the footer of our communications.
Are you currently homeless?*
Address*
$
Do NOT include your spouse/partner's income. Include your total monthly income from employment, unemployment, disability, social security, veteran's benefits, child support, TANF, etc. before taxes and deductions.

Head of Household Demographic Information

*NOTE* Responses in this section do not affect whether you qualify for services at the Center, but are required for grant writing and reporting purposes.

What is your race/ethnicity?*
In what country were you born?*
Is English your primary language?*

The Center offers three levels of FREE English Language Learning classes. For more information, visit cfpin.org/how-we-help/programs-and-services.

Can you speak English?*

*NOTE* While we do have some staff members who speak two or more languages, in general translators are not available at the Center for People in Need. If you cannot speak English, please have someone, not a child, available to assist with translation when contacting the Center for assistance.

Highest level of education achieved?*
Are you currently receiving SNAP (aka Food Stamp) benefits?*
Are you currently receiving ADC (Aid to Dependent Children)/TANF (Temporary Assistance for Needy Families) benefits?*

Additional Household Members

Do you have a spouse/partner to include on your application?*

Spouse/Partner Information

This section applies only to your Spouse/Partner. Minor/child family members may be added after this section.

Name of Spouse/Partner*
Has your Spouse/Partner used any other names?*
This could include maiden names, former married names, etc.
Date of Birth of Spouse/Partner*
Gender of Spouse/Partner*
You’ll receive updates related to the Center for People in Need at this email address. You can unsubscribe at any time by clicking the "update your preferences" link in the footer of our communications.
$
Include their total monthly income from employment, unemployment, disability, social security, veteran's benefits, child support, TANF, etc. before taxes and deductions.
What is your Spouse/Partner's race/ethnicity?*
In what country was your Spouse/Partner born?*
Is English their primary language?*

The Center offers three levels of FREE English Language Learning classes. For more information, visit cfpin.org/how-we-help/programs-and-services.

Can they speak English?*
Highest level of education achieved by your Spouse/Partner?*

Additional Household Members

Are there any other adults in your household?*
This includes any individuals who are 19 years old or older, regardless of their relation to you.

Center services are designed for one adult, their spouse/partner and all of their minor children (aged 18 and younger). If there are additional adult members of your household (age 19 and older), they will need to apply for their own Center Card to access services.

Are there any children (age 18 or younger) in your household? NOTE: You may not receive services for children not included on your application.*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #1

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember, you may not receive services for children not included on your application.

Name of Minor Child #1*
Date of Birth of Minor Child #1*
Gender of Minor Child #1*
What is Minor Child #1's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #2

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,  you may not receive services for children not included on your  application.

Name of Minor Child #2*
Date of Birth of Minor Child #2*
Gender of Minor Child #2*
What is Minor Child #2's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #3

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,  you may not receive services for children not included on your  application.

Name of Minor Child #3*
Date of Birth of Minor Child #3*
Gender of Minor Child #3*
What is Minor Child #3's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #4

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,  you may not receive services for children not included on your  application.

Name of Minor Child #4*
Date of Birth of Minor Child #4*
Gender of Minor Child #4*
What is Minor Child #4's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #5

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,  you may not receive services for children not included on your  application.

Name of Minor Child #5*
Date of Birth of Minor Child #5*
Gender of Minor Child #5*
What is Minor Child #5's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #6

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,  you may not receive services for children not included on your  application.

Name of Minor Child #6*
Date of Birth of Minor Child #6*
Gender of Minor Child #6*
What is Minor Child #6's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #7

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,  you may not receive services for children not included on your  application.

Name of Minor Child #7*
Date of Birth of Minor Child #7*
Gender of Minor Child #7*
What is Minor Child #7's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #8

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,  you may not receive services for children not included on your application.

Name of Minor Child #8*
Date of Birth of Minor Child #8*
Gender of Minor Child #8*
What is Minor Child #8's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #9

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,   you may not receive services for children not included on your  application.

Name of Minor Child #9*
Date of Birth of Minor Child #9*
Gender of Minor Child #9*
What is Minor Child #9's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

Minor Child Aged 18 or Younger #10

This section applies only to the first minor child member of your household. Additional minor children should be added after this section. Remember,   you may not receive services for children not included on your  application.

Name of Minor Child #10*
Date of Birth of Minor Child #10*
Gender of Minor Child #10*
What is Minor Child #10's race/ethnicity?*
Do you or your spouse/partner have additional minor children for which you have primary legal custody/guardianship?*
Only include individuals aged 18 or younger.

If you have more than 10 children for which you have primary, legal custody/guardianship, please submit your application and then call the Center at 402.476.4357 to report additional children.

Acknowledgement

By submitting this application, I declare that the information provided regarding family income and household members is true and correct. I understand that submitting false information may disqualify me from receiving Center services.

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