Helpful Forms

Forms and worksheets that you may need to include with your application can be downloaded from this page.

Application Forms

Employment Verification Form
This form can be filled out by an employer as a verification of wages earned.

Self Employment Form
Use this form if you are self-employed and have not yet filed a tax return.

Identification Form for Children Under 16
This form can be completed by your child’s school or day care to prove identity.  

*Note: Children 16 or older need to send a photo ID.

LOW COST & FREE HEALTH COVERAGE FOR UNINSURED KIDS & TEENS IN NEW HAMPSHIRE