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 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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