LIFE Program Application

Follow the steps to create a new LIFE application. Ver página en español.

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Determine your Eligibility

To complete the application, please have the following:

  • Photo ID
  • You have the option to self-certify or provide proof of income, such as:
    • Medi-Cal, EBT, any proof of public benefit, Social Security award, check stub or tax return, Or
    • Check Self-Certification below

Select the size and income within the following eligible income bracket that best describes your household.

Submit Annual Household Income

There are two ways to submit your annual household income: Self-Certification or Documented Income. Choose one.*

Self-Certification (Select if proof of income is unavailable)

  By checking this box, I confirm that the income level I selected above is correct. I understand that in the future, I may be asked to provide proof of income. I agree that if I do not provide proof of income, my benefits may be terminated in the LIFE Program.

   or   

Documented Income

  I will provide one income document to verify my annual income. I will upload it (in Step 3) as a digital file.

Verify your Identity

A photo ID is required for you and for each household applicant. View examples of ID documents that are accepted. Please upload your photo ID as a digital file in Step 3.

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