One item from each section is required unless otherwise indicated.
Additional documents may be needed to determine eligibility.
*Note: Minors are individuals aged 12-17 as defined in Section 6926 of the Family Code. Clients with Confidentiality Concerns refers to a client who has insurance through a parent, guardian, spouse, or domestic partner, but cannot use this insurance to access PrEP for confidentiality reasons.
- Drivers License
- State of local ID card (e.g. DMV issued ID, Municipal ID, student ID, or an ID from the Department of Corrections [CAL-ID])
- U.S. Passport
- Permanent Residence Card
- Employment authorization card
- Military ID card
- Photo ID issued by a foreign government (e.g. voter registration card, passport, or consulate ID card)
- Birth certificate (only if client does not have one of the ID's listed above)
- Provider Verification of Identity form
- Request for Services (for use with minors only)**
*Note: Expired cards may be used if no other form of picture ID is available
**Note: If a minor is unable to furnish any of the other IDs listed, the Request for Services Form can be used to establish their identity and status as a minor. This form is required to participate in PrEP-AP, even if it is not used for identity documentation purposes.
2. Proof of California Residency (Not applicable for minors)*
- These documents must be dated within thirty days, be in the client’s name, and include the client’s residential address:
- California rent or mortgage receipt
- Current utility bill with the service address listed in California (a cell phone bill is not acceptable)
- Employment paycheck stub
- These documents must be dated within one year, be in the client’s name, and include the client's residential address:
- Rental/lease agreement or annual lease renewal documentation
- Voter registration card
- W-2 or 1099 (prior tax year documents will be accepted until February 15th. After February 15th,only current tax year documents will be accepted.)
- Social Security/Disability Award Letter (SSI, SSDI)
- California Employment Development Department (EDD) award letter
- Filed State or Federal tax return
- Public housing letter on official letterhead from Housing and Urban Development (HUD) or a county agency
- Notice of Action from the Department of Health Care Services
*Note: Clients who do not have the above residency documentation may prove residency by completing and submitting the Residency Verification Affidavit form. A letter from the client’s PrEP-AP enrollment worker, on agency letterhead and containing the same information as found on the Residency Verification Affidavit form, is also acceptable.
3. HIV Negative Status
- Must be dated within six months of PrEP-Ap application
4. Additional Forms (provide all that apply)