You’re offline. This is a read only version of the page.
Skip to main content
Summer EBT Application
Toggle navigation
Home
Basic Form Pass to Liquid
Application Entry
Stand Alone Primary
Stand Alone Student
Stand Alone Adult
Stand Alone Child
Summer EBT Summary Page
Control Testbed
Redirect Page For Multipage
subgrid
Before You Begin
User Application Review
Member
School Search
List Filtering Testbed
FetchXML Test
Am I Eligible -Anon
HTML Integration
Am I Eligible
Old Radio Test
Radio Testing 2
Sign On and PowerFx Contols
Scratch Built HTML
Javascript Testbed
Control Pick Apart
1 Holder Page
Household Income Check
Income Ineligible
Income Eligible
Dynamic Income Count
Widgit
Income Check
Income Screener
New Liquid Donor
Frame Testing (1)
Test
English
English
español
Sign in
New Tab
This section is a standard form
Child First
*
Medicaid Number
*
*
Child Last
*
Student ID
*
Child DOB
*
Has Medicaid?
No
Yes
Is_Medicaid?
Is_Medicaid?
No
Is_Medicaid?
Yes
Has SNAP
No
Yes
This is a html web resource with inline images.
Attachment Display Label
