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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.
Name
Address
Please review the address you entered, this will be the address we send your benefit cards to.
Select the programs you participate in:
If this is your weekly CARE Grocery Card, select CARE Weekly Grocery Card
If this is your weekly NextUp Grocery Card, select NextUp Weekly Grocery Card
Pickup Type
Select the program requirement(s) you completed that you would like to receive benefit cards for:
EOPS/CARE/NextUp and CalWORKs Students; Deadline Dates: July 31st – October 6th
EOPS/CARE/NextUp and CalWORKs Students; Deadline Dates: September 11th – December 8th
EOPS/CARE/NextUp and CalWORKs Students; Deadline Dates: October 16th – December 8th
EOPS/CARE/NextUp Students; Deadline: Must be completed by December 8th
EOPS/CARE/NextUp Students; Deadline: Must be completed by December 8th
EOPS/CARE/NextUp Students; Deadline: Must be completed by December 8th
EOPS/CARE/NextUp Students; Deadline: Must be completed by December 8th
EOPS/CARE/NextUp Students; Deadline: Must be completed by December 8th
NextUp Students Only; Deadline: Must be completed by December 8th
CalWORKs Students Only; Deadline: Must be completed by December 8th
EOPS/CARE/NextUp Students; Deadline: Must be requested by December 8th
EOPS/CARE/NextUp Students; Deadline: Must be requested by December 8th
Benefit card you would like to receive:
By checking this box I understand that typing my name will be considered my official electronic signature.