Application to be completed by agency staff

*Required field.  Submit up to three youth applications for a LIFT cardholder on this page. For additional youth, submit this form, and complete and submit additional forms. Cards will be mailed within 10 business days.  Continue to give cardholders the paper form and envelope if they will be submitting the form on their own. Email ccshelp@kingcounty.gov or call 206.477.4553 with questions.

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* 1. First youth

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* 2. Second youth

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* 3. Third youth

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* 4. Mailing address (include apt or unit number)

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* 5. City

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* 6. Zip

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* 7. Phone (10 digits with no spaces or dashes)

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* 8. Email

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* 9. Parent/Guardian

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* 10. The parent or guardian understands that the youth card will be registered to the youth and associated to the account of the parent/guardian.

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* 11. I verified the youth's name and dob from state ID, birth certificate, passport, student ID, state benefits website or award letter.

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* 12. Agency

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