Please provide the following account information and submit this form only once.
Enter your name and address EXACTLY as they appear on the "Qualified" screen or in your email notification from the National Verifier. Failure to do so will result in your application being rejected, and the discount will not be applied to your Quantum Fiber account.
Required
Required
Required
Example: B12345-67890
Required
Required
Required
Required
Example: 12345
Required
Format: MM/DD/YYYY (Must be 18+ years old)
Required
Example: (987) 654-3210
Required
Please make sure your email address is correct

Do you qualify for the Lifeline program through your child or a dependent?

If you do not qualify on your own, you can sign up for the Lifeline program through your child or dependent if they participate in any of the qualifying programs.


Required
Your Child or Dependent's Information

Enter your child or dependent's name Exactly as it was entered into your Lifeline application with the National Verifier. Failure to do so will result in your application being rejected and the discount will not be applied to your Quantum Fiber account.

Required
Required
Required
Format: MM/DD/YYYY (Must be born)

Do you reside in a federally designated Tribal area?


Required

Are you a recipient of FEMA's Individuals and Households Program (IHP)?


Required

The Lifeline program is a Federal Communications Commission (FCC) benefit program of the federal government that reduces the cost of your broadband internet service bill.

You may obtain broadband internet service supported by the Lifeline program from any participating provider of your choosing, you may apply the Lifeline benefit to any of our broadband service offerings at the same terms available to households that are not eligible for the Lifeline program, and you may transfer your benefit to another provider at any time.

Enrollment Disclosures. If you transfer your benefit to another provider or the program ends, but you continue to receive service from Quantum Fiber, or if you are de-enrolled from the Lifeline program, you will be subject to the Quantum Fiber undiscounted rates and general terms and conditions.

Transfer Disclosures. If you are transferring your Lifeline benefit from another service provider to Quantum Fiber, the effect of the transfer will be that the Lifeline benefit will be applied to your Quantum Fiber service, not the service retained from the previous provider. If you choose to maintain service from your previous service provider, your previous service provider may charge you their undiscounted rates for that internet service.

You may contact Quantum Fiber customer centers, as applicable, for help with any Lifeline questions. If you have a complaint about your Lifeline service you may file it via the FCC's Consumer Complaint Center.

Required

Consent to Transmit Information to the Lifeline Program Administrator

To enroll you in the Lifeline Program, we must transmit the following information about your enrollment to the administrator of the program, the Universal Service Administrative Company (USAC) to ensure the proper administration of the program: your full name, full address, date of birth, and telephone number associated with your enrollment along with the same information (e.g.name, address, date of birth) of your minor child or dependent if your child or dependent is the basis for qualifying for benefits under the program. If you consent to us transmitting this information, please indicate so by checking the box below. If you do not consent, we will not be able to enroll you in the program and you will not receive the discount.

Required
How does Quantum Fiber protect my information? Read the Quantum Fiber privacy policy.