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COMMUNITY
PORTAL
New user registration for Arise S-EBT
Note
: If this is your first time applying for assistance, you will need to create an account. If you need help with filling out the application please contact 1-800-443-3536
Parent/Guardian Detail
First Name
Middle Name
Last Name
Date of Birth
Gender
Email
Password
Confirm Password
Social Security Number
Note:
Address is important. The address entered here will be used to mail your child’s Arise S-EBT card
Mailing Address
Note:
The fields 'Street 1', 'Street 2', and 'City' are limited to a maximum of 35 characters each. If an address exceeds this limit, standard abbreviations for common address components (e.g., 'St' for Street, 'Ave' for Avenue, 'Rd' for Road, 'SW' for Southwest) should be used to shorten the address appropriately.
Street 1
Street 2
City
State
Zip Code
County
Is Mailing Address different from Physical Address
Physical Address
Note:
The fields 'Street 1', 'Street 2', and 'City' are limited to a maximum of 35 characters each. If an address exceeds this limit, standard abbreviations for common address components (e.g., 'St' for Street, 'Ave' for Avenue, 'Rd' for Road, 'SW' for Southwest) should be used to shorten the address appropriately.
Street 1
City
State
Zip Code
County
Phone Number
Primary Phone Number Type
Primary Phone Number
Ext.
Alternate Phone Number Type
Alternate Phone Number
Ext.
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