Title Fund Family Survey
Please use the Income Eligibility Guidelines emailed to you.
First Name *
Last Name *
Home District (public school district where you reside) *
Children's Grades *
Required
Is your family income less than the amount in column 2(Federal Poverty Guidelines)? refer to attachment *
Is your family income less than the amounts in columns 3-5 (Reduced Price Meals)? refer to attachment *
Is your family income less than the amounts in columns 6-8 (Free Meals)? refer to attachment *
Are you receiving assistance under the Temporary Assistance to Needy Families (TANF) program? *
Are any of your children eligible to receive medical assistance under the Medicaid program? *
Home Address *
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