Follow the steps to successfully complete your application online.

1. Press the ‘Get Form’ button to access the application form and launch it in your editor.
2. Begin filling in the 'Client Name' section with the individual's name, followed by their date of birth and phone number. Ensure that this information is accurate and complete.
3. Indicate whether the client is under age 18 and if they are under the care of an adult who qualifies based on the outlined criteria by selecting 'Yes' or 'No'.
4. Record the client's MA number, Gray Zone number, or Medicare number, along with their Social Security number in the appropriate fields.
5. Document the current living situation by selecting one of the provided options, such as 'Emergency Shelter' or 'Living with Relatives/Friends'. Additionally, provide the zip code of the last residence.
6. Check the relevant boxes to indicate the client's housing status, which includes options like 'Literally Homeless' or 'Imminently Losing Housing'.
7. Fill in the section regarding the client's gender, race, ethnicity, and any disabilities they may have, ensuring to provide complete and accurate information.
8. Provide the name and contact information of the person completing the form along with their agency and address, if applicable.
9. Verify if documentation of homelessness is received by checking 'Yes' or 'No'.
10. In the 'Request' section, indicate the services being requested by checking all that apply: 'State Identification Card', 'Drivers License Renewal', or 'Birth Certificate'.
11. Once all sections are completed, review the information for accuracy. You may then save changes, download, print, or share the application as needed.

Complete your application online today to ensure you receive the necessary support.