Use this form to request that the Secretary of State verify your eligibility, and the eligibility of your children, for enrollment in public benefits programs or public schools. Participants should fill in their information and take this form to the public benefits agency or public school to be completed by a case manager or registrar. The form should then be submitted directly to the Safe at Home Program for verification and certification. Participants must ensure that their residential address is up to date and that the Safe at Home Program has fully verified their residential address prior to submitting the form.