SUN Bucks Opt-out Form

* required field

Please provide the following information to opt out of the SUN Bucks benefit. Please complete this form for each child you need to opt out of SUN Bucks.

There is a chance you may still receive a SUN Bucks card, if you happen to receive a card in error, you can destroy and dispose of the card.

First name of eligible child *

Last name of eligible child *

Name of the school the child attended in School Year 2023-2024 *

Child's date of birth *

Month

Day

Year

Custodial parent first name *

Custodial parent last name *

Custodial parent phone number *

Custodial parent email address *

Mailing Address *

If applicable, SNAP/TANF case number

Did you received a notification from the Arizona Department of Economic Security (DES) that one or more child(ren) in your household are eligible for 2024 SUN Bucks? *

Yes

No

Leave this field blank