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Arizona SNAP CAN Participant Assessment

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Arizona SNAP CAN Participant Assessment

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If you have questions, please email us at [email protected].

Are you ready to become a SNAP CAN Participant? Please complete the Arizona SNAP CAN Participant Assessment below and a member of the SNAP CAN team will contact you with next steps.

First Name *

Last Name *

Email Address *

Phone Number

Would you like a SNAP CAN provider to contact you directly?

Yes

Gender *

County *

Zip Code *

Age

Must be 16 years of age or older.

Do you have a criminal record? *

Yes

Are you currently receiving nutrition assistance Supplemental Nutrition Assistance Program (SNAP) benefits previously known as food stamps? *

Yes

Do you have youth 16 years or older in the household who would like assistance as well with education or training services? *

Yes

Do you have any barriers that might impact your ability to receive SNAP CAN employment services (examples may include a lack of transportation, child care, etc.)?

Reason for Contacting *

Adult Basic (ABE) - Improve your basic skills needed for college and employment

English as a Second Language (ESL) - Learn or improve your English

High School Equivalency (GED) - Earn a GED for employment

Vocational Training - Learn a new skill in culinary, construction, auto tech or other career paths

Job Search Help - Assistance with finding employment opportunities and applying for a job

Job Readiness - Prepare a resume, get help with a job interview and exploring a career path

Disclaimer *

By selecting "Agree" below, I am acknowledging that by submitting this contact form, I consent to a SNAP CAN Specialist using the information provided to contact me regarding any inquiries or issues identified in this form. I also confirm that I have not submitted personal and/or confidential information that I do not wish DES or a SNAP CAN Partner to access. The information collected in this form is protected in accordance with our website’s privacy policy

Agree

Leave this field blank

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Pursuant to Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA) and other nondiscrimination laws and authorities, ADES does not discriminate on the basis of race, color, national origin, sex, age, or disability. Persons that require a reasonable modification based on language or disability should submit a request as early as possible to ensure the State has an opportunity to address the modification. The process for requesting a reasonable modification can be found at Equal Opportunity and Reasonable Modification.

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