ACP Opt In – American Assistance

IMPORTANT AFFORDABLE CONNECTIVITY PROGRAM (ACP) NOTICE The ACP program is suspended until Congress provides funding – please check back often for more information.

Affordable Connectivity Program (ACP) Opt-In Form

Please fill out the form below to enroll and begin receiving Affordable Connectivity Program (ACP) benefits.

Select Your State

Name

First

Middle

Last

Date of Birth

SSN - Last 4

Current Lifeline Phone Number

ACP Add-on Approval

Yes, I Authorize

Please click here and we will load this plan monthly on top of your existing Lifeline plan, for FREE, using your current phone number for your convenience right after you opt-in below.

EBB Benefits Approval

Yes, I Authorize

Please click here to also affirm that I want to continue to receive my EBB benefit for the next 30 days.

Authorization Agreement

Yes, I Authorize

I authorize American Assistance and its contracted partners, for the purpose of applying for, determining eligibility, enrolling in and seeking reimbursement of Emergency Broadband Benefit Program (EBBP)

Privacy Agreement

Yes, I Agree

I agree that any state, local, Tribal government, school or school district, may share information about my receipt of benefits that would establish eligibility for the EBBP, and that such information will be used only to determine EBB eligibility.

Consent Agreement

Yes, I Consent

I give express consent for American Assistance and its contracted partners to contact me to validate my eligibility for or desire to participate in American Assistance's EBB offers, and other products and services via email, telephone, or text messaging. Text messaging and data rates may apply. Consent for calls and texts is optional and can be revoked at any time. For more information see our Terms and Conditions and Privacy Policy at AmericanAssistance.com.

ACP Transfer Consent

Yes, I Conscent

Where applicable, I consent to transfer my services from my existing ACP provider to American Assistance.

ACP Opt-In Confirmation

Yes, I Confirm

By clicking on the SUBMIT button, you acknowledge and confirm that you have read and understand the disclosures below and to OPT-IN to your EBB discounted broadband service.

If you are human, leave this field blank.

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