Application MUST be completed online and all documentation listed below must be uploaded.
Electronic copy of most recent submitted IRS 1040 Tax Form. If the child is not listed on your most recently filed IRS 1040, please provide a copy of both your most recently filed IRS 1040 and the most recently filed IRS 1040 on which the child is listed as a dependent. Additional documentation may be required in the event that your child is not on your most recent IRS 1040 (e.g. recent birth, adoption, etc.)
Electronic copy of the front and back of current Commercial/Private insurance card.
Completed and signed Physician Certification of Medical Condition Form.
Do you have all of the required documentation? Ready to Apply?