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PDFWAC 434-840-010

Application process.

(1) The secretary of state shall certify an eligible person as a program participant when the secretary of state receives an application that contains:
(a) The full legal name and date of birth of the applicant(s);
(b) A listing of all minor children residing at the residential address, each minor child's full legal name, and each minor child's date of birth, and each minor child's relationship to the applicant;
(c) A listing of all adults residing at the residential address requesting participation, each adult's full legal name, date of birth, and relationship to the applicant;
(d) The Washington state residential addresses, work, and school addresses, if any, for which confidentiality is requested;
(e) The telephone number of the applicant(s);
(f) The address to which mail should be sent, this may be the same as the residential address;
(g) A sworn statement, under penalty of perjury, by the applicant, that the applicant has good reason to believe either:
(i) That the applicant, or the minor or incapacitated person on whose behalf the application is made, is a victim of domestic violence, sexual assault, trafficking, or stalking, and that the applicant fears for their safety or the safety of their children, or the safety of any minor children or incapacitated person on whose behalf the application is made; or
(ii) That the applicant, as a criminal justice participant as defined in RCW 9A.46.020, is a target for threats or harassment prohibited under RCW 9A.46.020.
(h) The state of Washington personnel number, if the applicant or any of the persons covered by the application is a Washington state employee;
(i) The applicant's signature;
(j) The date on which the applicant signed the application;
(k) The signature, printed name, and phone number of the application assistant designated by the secretary of state under RCW 40.24.080 who assisted in preparation of the application;
(l) A completed checklist of understanding, signed and dated by the applicant designating the secretary of state as legal agent for purposes of service of process and for the purpose of receipt of mail.
(m) Signed authorization card form for each member of household.
(2) The application must be completed and signed in the presence of an application assistant;
(3) The application assistant shall submit completed applications and any additional materials to the secretary of state using first class mail; and
(4) If the completed application does not meet the requirements of this part, the secretary of state shall contact the applicant to obtain missing information. The applicant shall be certified only if the missing information is provided.
[Statutory Authority: RCW 40.24.090 and 40.24.030. WSR 19-12-002, § 434-840-010, filed 5/22/19, effective 6/22/19. Statutory Authority: RCW 40.24.090. WSR 08-23-094, § 434-840-010, filed 11/19/08, effective 12/20/08; WSR 98-19-063, § 434-840-010, filed 9/16/98, effective 10/17/98. Statutory Authority: 1991 c 23. WSR 91-20-074, § 434-840-010, filed 9/26/91, effective 10/27/91.]
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