To qualify, you must have a Medicaid, WIC or EBT card, a Social Security Disability letter (not Social Security), or a 1040 Form showing that your annual household income is $35,000 or less.   To apply, please fill out the form below and attach a copy of your Driver's License and ONE of the required documents.  If you use your 1040 Form to qualify, please block out your Social Security Number.