IDignity Seminole Client Service Request Form

I'm in need of servicesI'm requesting services for somebody else

Born a US CitizenBecame a US CitizenLegal ResidentIf the client does not have legal US residency, IDignity will not be able to assist. We recommend reaching out to an immigration attorney for assistance in obtaining legal status.

Please indicate state of birth if born in the US, or the country you were born in.

I will bring somebody with me to translateI need translation assistanceNo, I also speak EnglishIDignity cannot promise that translation assistance will be available, but will try to accommodate.

Florida Identification or Drivers LicenseSocial Security CardUS Birth Certificate

Yes - Valid Florida IDYes - Valid ID from another stateYes - Expired IDYes - Photocopy or picture of an IDNoUnsure

Yes - Original / Certified CopyYes - PhotocopyYes - Unsure if it's original or notNoDon't KnowYou can often tell by checking for a raised seal on the document.

Two of the following: Proof of current private residence (lease, mortgage, etc) or bills, employer documentation, financial statements, or mail from government agencies from the last 60 daysProof of residence at a shelter or transitional program from the last 60 daysProof of homelessness (letter from agency) from the last 60 daysLetter of residency from person client is living with, as well as 2 proofs of that person's address from within the last 60 days (they will need to be physically with the client or notarized; IDignity can provide the notarized form for you)Unhoused and do not have a letter

If none, please leave blank

I would prefer to set an apppointment. Please contact me to schedule. I would prefer to walk in without an appointment before 11am.

IDignity Seminole Client Service Request Form

Please complete this form if you or someone you know needs assistance from IDignity.

Submitter Information

Client Information