1. CHILD INFORMATION
List all children currently living in your household.
2. PERSONAL USE MONTHLY INCOME
If this application is for a child who is the legal responsibility of a welfare agency or court, list the amount of the child’s personal use monthly income.
3. ADULT MONTHLY INCOME
List all adults currently living in your household. List total gross monthly income before taxes and deductions for each.
Other Adults: List names, employers, and monthly income.:
4. ADDITIONAL INFORMATION
*Applicant Marital Status:
Additional information you would like to provide to help the committee understand your need (optional):