Name * First Name Last Name Last 4 Digit of Social Add only the last 4 digits (Optional) Email * Phone (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country How do you qualify * choose one option Pell Grant in the current award year SNAP / Food Stamps / CalFresh Supplemental Security Income (SSI) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Qualifying Tribal Lands in United States Section 8 / Federal Public Housing Assistance (FPHA) Veterans Pension and Survivors Benefit Thank you! A Worx Wireless representative will be in contact with you soon. APPLY TODAY APPLY TODAY APPLY TODAY
