• Lifeline Phone Service Enrollment Form

    Apply for discounted phone service through the Lifeline program. Please provide accurate information to determine your eligibility.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Are you currently enrolled in any of the following government assistance programs?*
  • If you are not enrolled in a government program, is your total household income at or below 135% of the Federal Poverty Guidelines?*
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  • Is this your only Lifeline benefit?*
  • Should be Empty:
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