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More Ways to Give
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SNAP Ambassadors Monthly Reporting Upload Portal
Organization Name
Helping Hands Las Animas
La Puente Home
NeighborWorks
Westside Cares
SNAP Ambassador Name
Applicants Name
First
Last
Date of Birth
MM slash DD slash YYYY
ZIP Code
Phone
Email
Number of People in the Household
Number of Children
Number of People 60+
SNAP Disability Eligible
Yes
No
SNAP Application Type
New App-New Application
RRR-Recertification
PRF-Periodic Report Form
CR-Change Report
Application Submission Date
MM slash DD slash YYYY
Peak Tracking # (AND Case # if applicable)
Telephonic Signature
Yes
No
Ethnicity
Hispanic / Latino
Non Hispanic / Latino
No Response
Race
Asian
Black / African-American
Native American
No Response
White Caucasian
American Indian/ Alaskian Native
Native Hawaiian / Pacific Islander
Other ( Enter a value below)
Gender
Male
Female
Non-Binary
Other Race
Employment
Full Time
Not Working
Part Time
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