Equifare Application Program - My ASP.NET Application

2. Verification

Verify the above information by selecting ONE of the option below.

2a. Self-Certification

By checking this box, I verify that the income level I selected above is correct. I understand that in the future, I may be asked to provide proof of income. I agree that if I do not provide proof of income, my participation in the Equifare program may be terminated.

2b. Proof of Eligibility

By checking this box, I verify that I have included proof of income or social service enrollment (such as Medi-Cal, EBT, Social Security Award, check stub or tax return) alongside this application. By providing proof of eligibility at this time, I will not be selected for an audit. I am self-employed or have low-to-no income and I will submit the required Personal Income Declaration form if asked.

Upload Documents[Only Image and PDF file]

3. Applicant Information

First Name

Last Lame

Birth Date

Mailing Address

Apt Number

City

State

Zip

Phone Number

Email Address (Use the address associated with your AMP account)

If you are not the head of your household and require another person's documents in order to prove program eligibility, please provide their information below.

First Name

Last Name

Birth Date

If enrolled by an organization, provide enrolling assistant's information below.

Organization Name

Enrolling Assistant's Name (First and Last)

4. Confirmation and Consent

Do you currently have AMP Card?

Yes - I do. No - I would like a physical AMP card. Please mail to the above address. No - I would like and will create a virtual AMP card.

Please sign me up to receive communication about CapMetro products or services

By checking this box, I agree that the information I have provided is accurate. I understand that all personal information will be kept confidential. If approved, I agree to follow the rules and guidelines established by Capital Metro. I understand that if I am approved for the Equifare Program, and if I abuse or misrepresent the benefits of Equifare in any way, my participation in the program and future eligibility may be terminated.

Equifare Program Enrollment Form

1. Program Eligibility

1a. Household Income Eligibility

1b. Social Service Eligibility

2. Verification

2a. Self-Certification

2b. Proof of Eligibility

3. Applicant Information

4. Confirmation and Consent