OpporZOOnity Registration Form

Residency Requirements

Eligibility is based on residency in select Pennsylvania counties—enter your zip code below to continue.
Please enter your zip code below to check eligibility.
Valid Zip Code
Unfortunately, based on the eligibility criteria, you do not qualify for participation at this time.

If you believe this decision was made in error or have any questions, you may try submitting the form again or contact us at 412-665-3640 or OpporZOOnity@gmail.com.
Your ZIP code matches the eligibility criteria.

Click Next to continue with the registration form.

Contact Information

One name only per form. If multiple Electronic Benefits Transfer (EBT) cardholders are in a household a separate form will need to be submitted.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
E-mail*
Enter the email you want to receive communications and program status.
Phone Number*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Zip Code*
Please enter a valid U.S. ZIP code (e.g., 12345)

Demographic Information

We ask these questions to help ensure that our services and programs meet the needs of our diverse community. Providing this information is completely optional and will not affect your participation.
How many children are in your household (aged 17 or younger)?
Type a question

American Indian or Alaskan NativeAsianBlack or African AmericanHispanic, Latino, or Spanish originMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderWhite / CaucasianPrefer not to answerOther

Household Members
Will another member of your household who has an EBT card be submitting a separate registration form?*

YesNo
What is the full name of the additional person in your household submitting this form?
Enter Full Name
What is your relationship?

Spouse/PartnerParent/Legal GuardianChildSiblingFamily MemberOther

Confirm Your Eligibility for OpporZOOnity Program

Applicants must submit a valid EBT card and government-issued photo ID for verification. Both the card and ID must match to be accepted
We take your privacy seriously:
- The documents you upload will only be used to verify your membership in the EBT program.
- The cards this program accepts are:
- All uploaded files will be securely deleted after your eligibility has been confirmed.
To confirm your eligibility for the program, please upload:
1. A photo of your EBT card
2. A photo ID that matches the name on the EBT card and address must be in one of the accepted Pennsylvania counties.
If you have concerns or need assistance, please contact us at Contact us at 412-665-3640 or OpporZOOnity@gmail.com
Upload Your Documents

Please upload required documents, or if you prefer, take a picture of them. Both options are available below. Make sure your documents are clear and legible.
Instructions for Document Upload:

Before uploading your file, please name it using the following format:
- FirstLast_DateOfApplication (For example: JaneDoe_01-01-2025)
- Make sure the images are clear and all text is legible.
- Accepted file formats: JPEG, PNG, or PDF
Failure to follow this naming convention may delay processing.
Upload Documents

File Format: FirstLast_DateOfApplication (For example: JaneDoe_01-01-2025)
Cancelof
Take a picture

I confirm that I have read the instructions, uploaded BOTH required documents (a valid EBT card and government-issued photo ID), and understand that failure to follow these instructions may result in denial.*

Yes
Should be Empty:

Residency Requirements