Form download instructions
Important — Download this form before completing it
State eForms PDFs must be downloaded and saved to a Windows or macOS laptop or desktop computer before completion. Do not fill out the form in your web browser.
Open the saved PDF in Adobe Acrobat Reader (free), Acrobat Standard, or Acrobat Pro. Browser PDF viewers may disable calculations, validation, tab order, or other form functionality or may prevent entered information from being retained correctly.
Using a phone or tablet?
When the SPACES Self-Service Portal (SSP) can perform the task, use SSP to apply for assistance and manage your case online.
Apply or manage your case in SSP
Paper applications are available upon request.