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The Affordable Connectivity Program (ACP) is a U.S. government program that helps many low income households pay for broadband service and internet connected devices.
Need help? Text 434-329-1869
Affordable Connectivity Program Application

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Full Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who receives government assistance?*

MyselfSomebody else in household
SSN(Social Security) Last 4 Digits *
Date of Birth*
* ONLY if you chose somebody else in household

Fill out the information below
Full Name

First NameLast Name
Qualifying Beneficiary Details SSN(Social Security) Last 4 Digits
Qualifying Beneficiary Details Date of Birth
Federal Assistance Programs | You are eligible for the ACP if you (or someone in your household) participate in one of these programs:*

Supplemental Nutrition Assistance Program (SNAP), formerly known as Food StampsMedicaidSpecial Supplemental Nutrition Program for Women, Infants, and Children (WIC)Supplemental Security Income (SSI)Federal Public Housing Assistance (FPHA)Veterans Pension and Survivors BenefitFree and Reduced-Price School Lunch Program or School Breakfast Program, including at U.S. Department of Agriculture (USDA) Community Eligibility Provision schoolsReceived a Federal Pell Grant in the current award yearBased on your income
Based on Your Income
You are eligible for the ACP if your income is 200% or less than the Federal Poverty Guidelines (see the table below). The guideline is based on your household size and state.

The table below reflects the income limit by household size, which is 200% of the 2022 Federal Poverty Guidelines.
REQUIRED: W-2(2021) OR Current Award-Benefit Letter(2022) Required for Medicare, Income Based, Veteran Pension & Survivor Benefits

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FREE INTERNET + FREE SERVICE

Need help? Text 434-329-1869

Affordable Connectivity Program Application

* ONLY if you chose somebody else in household