S-EBT Application

Application for Summer Electronic Benefit Transfer (SEBT)

Before you begin there are a few things you should know.

To be eligible for Summer EBT benefits through an application, your child must:

• Live in a household where the total household income is at or below 185% of the Federal Poverty Level.  See income guidelines at  https://outside.vermont.gov/dept/DCF/Policies%20Procedures%20Guidance/ESD-SEBT-Income-Requirements.pdf.
• Be enrolled in a school that participates in the National School Lunch Program (NSLP) during the 2024/2025 school year.

 

Step-by-Step Application Process 

  1. Complete one application per household. Answer questions completely and honestly. An asterisk (*) indicates a required field. You must complete this application in one session. You cannot leave the application and come back later to finish it. If you leave before it is complete and submitted, your information will not be saved. You will need to start a new application.
  2. If the household has recently moved, please apply for benefits in the State where your child will complete or has completed the school year 2024-2025. 
    1. Completing all fields including optional fields may help speed up your application’s review.  It can take up to 30 days to process an application.
  3. Sign the application. Before you sign, be sure you read and understand the Rights and Responsibilities. 
  4. Submit your completed and signed application.
  5. Submit any additional documents requested. After you submit your application, we may ask you to provide further documentation to verify certain information. Please send copies of personal documents. Originals may not be returned. 

Any questions? We can help! 

Call: 1-888-354-0012, option 7 

TTY/RELAY: If you are deaf, hard of hearing, or have a speech disability, dial 7-1-1 for a free relay service. 

This program is provided as a benefit on an EBT card. Fill out this page with the details of the parent or legal guardian who the EBT card should be issued to.

Please provide an address where you would like your summer EBT card to be sent

Tell us about each child living at home

List all children, infants, and students up to and including grade 12 living in the household, even if they are not applying for benefits.
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race
Do you need to add another child?
Gender
If no income, enter 0:
Optional: The following is voluntary. It will not affect eligibility. It is asked only to assure that benefits are distributed without regard to ethnicity, race, color, or national origin.
Ethnicity
Race

Tell us about the adults living at home

List all adult household members (anyone living with you and shares income and expenses, even if not related, including you.) and income for each member (before taxes and deductions). Examples of income include but are not limited to: child support, pensions, retirement, social security, unemployment compensation, wages from employment (salary, wages, bonuses, tips, commissions), self-employment.
Is there another adult living with you in the home that shares income and expenses, even if not related?
Is there another adult living with you in the home that shares income and expenses, even if not related?
Is there another adult living with you in the home that shares income and expenses, even if not related?
Is there another adult living with you in the home that shares income and expenses, even if not related?
Is there another adult living with you in the home that shares income and expenses, even if not related?

Rights and Responsibilities

Income Guidelines

https://outside.vermont.gov/dept/DCF/Policies%20Procedures%20Guidance/ESD-SEBT-Income-Requirements.pdf.

Duplicate Benefits: If you receive more than $120 per eligible child in your household, do not use the benefits, and contact 1-888-354-0012, option 7 as soon as possible to confirm or correct the error. 

If you intend to move, or have recently moved, you should apply for benefits in the State where your child completed school year 2024-2025.

Americans with Disabilities Act (ADA): If you have a physical or mental condition that considerably limits a major life activity (e.g., moving, seeing, or thinking), you may be entitled to reasonable accommodations to help you participate in ESD programs. Call 1-888-354-0012, option 7. 

Right to Appeal: I have the right to appeal any decision I disagree with. I may request a fair hearing if benefits are delayed, denied, ended, or changed. My case may be presented by the head of household or a representative, such as a lawyer, relative, friend, or other spokesperson. To begin the process, I may call the Summer EBT support line at 1-888-354-0012, option 7; write to ESD Deputy Commissioner, Department for Children and Families, HC 1 South, 280 State Drive, Waterbury, VT 05671-1020; or write to the Human Services Board, 14-16 Baldwin St., Second Floor, Montpelier, VT 05633-4302. 

USDA Nondiscrimination Statement (DO NOT SEND APPLICATIONS TO THE USDA) 

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity. 

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. 

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by: 

mail: 
U.S. Department of Agriculture 
Office of the Assistant Secretary for Civil Rights 
1400 Independence Avenue, SW 
Washington, D.C. 20250-9410; or 

fax: 
(833) 256-1665 or (202) 690-7442; or 

email: 
Program.Intake@usda.gov 

This institution is an equal opportunity provider. DO NOT SEND APPLICATIONS TO THE USDA. 

Processing your application
 
The Richard B. Russell National School Lunch Act requires that we use information from this application to determine who qualifies for Summer EBT benefits. We can only approve complete forms. We may share your eligibility information with education, health, and nutrition programs to help them deliver program benefits to your household. Inspectors and law enforcement may also use your information to make sure that program rules are met. Some children qualify for Summer EBT without an application. Please contact your State or Indian Tribal Organization to get Summer EBT for a foster child, and children who are homeless, migrant, or runaway. 

Confidentiality: 

Information about my application and benefits is confidential and protected by state and federal law. ESD will not share any information about me unless it is directly connected to program administration, allowed by law or a court order, or I give my permission. 

I understand the information I provide on this application is subject to verification by federal, state, and local officials, and that I am responsible for its accuracy. This includes information about my spouse or civil union partner, children, and other members of my household. I authorize ESD to contact employer(s) to verify employment and income information for the purpose of determining my household’s eligibility for benefits. If I do not want ESD to contact employer(s), I must call the Summer EBT support line immediately at 1-888-354-0012, option 7. If the information I provide is not accurate my benefits may be reduced, I may be asked to repay benefits, I may be denied benefits, and/or I may be subject to an administrative disqualification hearing and/or criminal prosecution. 

I MUST NOT lie or hide information to get benefits my household should not get. I understand it is fraud if I or any adult in my household knowingly, with general or specific intent, gives false or misleading information, in order to get, attempt to get, or help someone else get Summer EBT. 

 I MUST NOT misuse EBT cards. I understand that misusing EBT cards in the following ways is considered trafficking: 

  • I MUST NOT sell my Summer EBT benefits. 
  • I MUST NOT trade for or use Summer EBT to buy non-food items, alcohol, tobacco products, illegal drugs, firearms, ammunition, or explosives. 
  • I MUST NOT let anyone use my EBT card, other than to buy food for my household. 
  • If I purchase food on credit, I MUST NOT use Summer EBT to pay off that credit, even if I charged food only. 
  • I MUST NOT use or have in my possession someone else’s EBT card(s), unless I’m purchasing food for their household. 

 

Signing

I certify (promise) that all information on this application is true and correct and that all income and household members are reported. I understand that this information is given in connection with the receipt of Federal funds, and that Economic Services may verify the information provided. I am aware that if I purposely give false information, I may be prosecuted under applicable State and Federal laws. I attest that I am not already receiving a Summer EBT benefit in another State for the children that I am applying for.

A non-household member may be designated as the authorized representative for application processing purposes if you have difficulty completing the application process. If you would like an authorized representative, complete this section.