APPLICATION FOR ASSISTANCE - Nevada
Important Notice: If you are applying for a child not eligible for M edicaid assistance on this application, the Nevada √ Check Up Program provides low-cost, comprehensive health care coverage to uninsured children 0-18 years of age who are not covered by private insurance or Medicaid. To find out the eligibility requirements for
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NEVADA STATE DIVISION OF WELFARE AND …
dwss.nv.gov2522-EE (10/14) Page 1 of 2 NEVADA STATE DIVISION OF WELFARE AND SUPPORTIVE SERVICES INFORMATION NEEDED TO PROCESS YOUR APPLICATION You or your representative must provide the following items as they apply to your household.
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DIVISION OF WELFARE AND SUPPORTIVE SERVICES …
dwss.nv.govYou must answer all questions. Please PRINT OR TYPE answers in black or blue ink. Check Yes, No, Unknown or write N/A (not applicable) in any space which does not apply.
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