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What is Lifeline?

Lifeline is a program designed to increase the availability of telecommunications services to low
income subscribers by providing a credit to monthly recurring local service for qualifying residential
subscribers. Link-Up provides a credit on the non-recurring installation and service charges to
qualifying residential subscribers.



APPLICANT INFORMATION:

First:
Name: Last: M:
(Please use the name your benefits are received in)

Address:
Street: Apt #   Flr/Bldg:    

Region:
City:     State:    Zip:  
(Address must be your principal residence)



Current Tel #:  ( ) - - Current Tel Co name

Email Address: (if applicable) **Contact #  
                               **(It's very important we have a contact # as a way to contact you, if possible. Not having one might delay your order.)


I do not currently have telephone service

I currently have telephone service

I currently receive monthly Lifeline assistance for the above phone line.
(Note: Lifeline assistance may only be applied to one phone line at your principal residence)...
I previously received Link-Up assistance at the above address.

.A member of my household had received Link-Up assistance at the above address. 
       (Note: You may not receive Link Up assistance more than once at the same principal residence.)


ELIGIBILITY REQUIREMENTS

     Please select the programs below that you currently participate in.





Medicaid (All BellSouth States, except TN)


Food Stamps (All BellSouth States)




Temporary Assistance to Needy Families - TANF (All BellSouth States)




Supplemental Security Income (All BellSouth States, except SC)


National School Lunch Program (must qualify for free lunch). FL, KY, LA, MS, TN


Low Income Home Energy Assistance (LIHEAP) AL, FL, GA, KY, LA, NC, MS, TN


TennCare (TN Only)




Federal Public Housing Assistance(SECTION 8) AL, FL, GA, KY, LA, MS, NC, TN




Household Income based on Federal Poverty Guidelines *Proof of Income Required*
(FL, LA, MS, TN)