To submit this form, complete all required fields and attach photocopies of documentation proving your household's SNAP participation. Sign and date the form. Submit the final form and attached documents via mail to Access from AT&T, PO Box 5030, Charleston, IL 61920-5030, via fax to 1-855-933-2423, or via email to ATTaccess@solixinc.com. Ensure all information is accurate and documents are properly attached before submission. For best results, use PrintFriendly to fill ou...

The important dates for this form in 2024 and 2025 include the annual recertification dates. Ensure you submit your recertification form before the deadline each year to continue receiving the discounted service. AT&T will notify you of your specific recertification dates in advance.

The purpose of this form is to provide low-income households with a means to apply for affordable wireline home internet service from AT&T. Eligible households must have at least one member participating in the Supplemental Nutrition Assistance Program (SNAP). By completing this form, applicants can benefit from significantly reduced internet costs, enabling access to essential online resources for daily needs and opportunities.

• 1. Applicant First Name: The first name of the applicant.
• 2. Middle Initial: The middle initial of the applicant.
• 3. Last Name: The last name of the applicant.
• 4. Service Address: The street address where the service will be provided.
• 5. City: The city where the service address is located.
• 6. State: The state where the service address is located.
• 7. Zip Code: The zip code of the service address.
• 8. Mailing Address: The mailing address for the applicant.
• 9. Home Phone Number: The home phone number of the applicant.
• 10. Cell Phone Number: The cell phone number of the applicant.
• 11. E-Mail Address: The email address of the applicant.
• 12. Date of Birth: The applicant's date of birth.
• 13. Social Security Number: The last 4 digits of the applicant's social security number.
• 14. Taxpayer ID or Tribal ID: The applicant's taxpayer ID or tribal ID.
• 15. SNAP Benefit Qualifying Person: The name of the SNAP benefit qualifying person, if different from the applicant.
• 16. Certification: A section for the applicant to certify their SNAP participation and agree to the program terms.
• 17. Signature: The applicant's signature and date.
• 18. SNAP Benefit Qualifying Person's Signature: The signature and date of the SNAP benefit qualifying person, if different from the applicant.
• 19. How Did You Hear About This Program: Options to indicate how the applicant heard about the program.

If you fail to submit this form, you will not be able to participate in the AT&T Access program and receive discounted internet service.

• Loss of Discounted Internet Service: You will not receive the low-cost internet service from AT&T.
• Missed Opportunities: You will miss out on access to essential online resources at an affordable rate.
• Reapplication Requirement: You may need to reapply and restart the application process for future consideration.

• 1. New Application: Submit this form when applying for the first time.
• 2. Annual Recertification: Use this form to recertify your eligibility for the program each year.
• 3. Update Information: Submit an updated form if your personal or contact information changes.
• 4. Household Changes: Use the form to report any changes in household members participating in SNAP.