YES to the Future – TANF Youth Application SECTION 1: Information About Young Adult ApplicantApplicant’s Name* First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security Number* Date of Birth (MM/DD/YYYY)* DD slash MM slash YYYY Phone*SECTION 2: Citizen/Non-Citizen StatusA. Are you a United States Citizen?* Yes No B. If you are not a United States citizen, tell us which status applies to you. Permanent Alien Refugee/Asylee SECTION 3: Household Size & IncomeA. BenefitsWhich programs, if any, do you currently receive benefits? (Check all that apply)* TANF SNAP Medicaid SSI LiHeap None If NONE, complete Item B.B. IncomeHousehold size (only includes youth and spouse and/or child(ren) if applicable):Personal monthly gross earned income of the youth (only includes youth, spouse, and child(ren)):NameIncome SourceAmountWeekly, Monthly, Yearly Signature*By signing this, I am swearing, under penalty of perjury, that all of the above statements are true to the best of my knowledge and that I am willing to cooperate with any efforts to verify the information providedDate* MM slash DD slash YYYY Quicklinks Explore Careers Specialized Services Building Green Futures Build Skills Job Seeker Success Stories Additional Resources & Support Forms & Policies
