Benefit Card Mail Request

Please complete this request form to have your benefit cards mailed. Keep in mind that staff will verify if you are eligible to receive benefit cards after your form is submitted.

Only students that live outside of the Barstow area can request to have benefit cards mailed to them.
Students that live in the Barstow area must pick up benefit cards in person. Benefit cards must be picked up by the student only, no exceptions.
If you are on program probation, you will only receive one (1) benefit card per requirement completed.
Students strictly on the CalWORKs Program will only receive one (1) benefit card per requirement completed.
For students in the CARE Program, weekly grocery cards must be requested before midnight of every Friday. Weekly cards cannot be requested for a missed/previous week and are not available when classes are not in session.
We are not responsible for lost, stolen, or misplaced benefit cards.
Benefit cards do not roll over to future semesters and must be requested in the current semester.

Program incentives are based on program funding and will be given out on a first-come-first-served basis.

Student B Number

First

Last

Address

City/Town

State/Province

ZIP/Postal Code

Please review the address you entered, this will be the address we send your benefit cards to.

Select the programs you participate in:

EOPS

CARE

CalWORKs

NextUp

If this is your weekly CARE Grocery Card, select CARE Weekly Grocery Card

CARE Weekly Grocery Card

Select benefit card(s):

NextUp Weekly Grocery Card

Gas Card

Walmart Card

Pickup Type

Mail-Out Request

In-Person Pickup

Benefit card you would like to receive:

Gas Card

Grocery Card

Walmart Card

CARE Weekly Grocery Card

I will pick up my weekly card, do not mail it out.

Please note that tutoring hour credit will be given based on the LAST date on the submitted Tutoring Hour Log Sheet. (For example, if you complete two hours on August 27th and two hours on September 3rd, the credit will count towards the month of September. If you want to utilize all five opportunities for the semester, we recommend completing all four hours within the same month.)

Please see the SPS Term Dates Flyer for all deadline dates.

I understand that benefit cards will be mailed in 7-10 business days and SPS is not responsible for any lost, stolen or misplaced benefit cards.

Signature Waiver

By checking this box I understand that typing my name will be considered my official electronic signature.

Student Signature

Date

Main Campus

Fort Irwin Campus