Forms

Food Stamp Exit Form

This form is to be completed by drug and alcohol treatment facilities when a client leaves the facility.

The form is used to verify that at the time of exit, the facility provided the client with their Dakota EBT card and gave them instructions to contact their local Department of Social Services office for EBT training.

The form can also be used to report that the client left the facility without proper notification.

• Complete form.
• Once you have completed this form, submit it to your local Department of Social Services office.