Note: Translation services are available on Firefox, Chrome and Safari browsers. If your P-EBT application was denied and you think this was a mistake, please fill out this form. Please complete one form per child. Please provide information about the parent or guardian. First Name * Middle Name Last Name * Phone * Email Please provide an email address if you have one. If you do not provide an email address you will not receive any communications or updates regarding your appeal. What is the legal name of the child who did not receive P-EBT benefits? First Name * Middle Name Last Name * Date of Birth* Confirm Date of Birth* What is the address your school has on file for your child? Street Address * P.O. Box or Apartment number City * Zip * Would you like your card mailed to another address? Street Address * P.O. Box or Apartment number City * Zip * Would you like to add another address that you think the school might have on file for your child? This will help us match your child with the school database. Street Address * P.O. Box or Apartment number City * Zip * What is the school the child attended for the 2019-20 school year? School Name* School District City * County * Submit
