This signed Affordable Connectivity Program (ACP) Enrollment Form is required to enroll you in Foothills Communications' ACP
Program. The National Verifier, not Foothills Communications, determines your eligibility to receive ACP. Only persons who
have been determined to be eligible by the National Verifier, or are currently receiving the Lifeline discount through
Foothills Communications, should complete this Enrollment Form. If you do not currently receive the Lifeline discount and
have not qualified for ACP through the National Verifier, please visit www.affordableconnectivity.gov to apply.
The information you enter on
this Enrollment Form must be exactly the same as what you provided to the National Verifier to receive eligibility approval,
which expires after 45 days. Submission of this form does not guarantee an immediate ACP discount with Foothills Communications