Voluntary Low Income Initial Review Form
In order to be considered for this process, we ask for you to submit this preliminary information.  Please note, if upon review of this information it is determined that we should proceed with next steps, additional written supporting documentation will be requested from parents/guardians to verify your annual household income (e.g.: paystubs, Social Security, pensions, or retirement statements; Unemployment, disability, or worker’s compensation statements; Public Assistance, Child Support or Alimony statements).
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Student First Name *
Student Last Name *
City / Town of Residence. *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian Best Email *
Parent/Guardian Best Daytime Phone *
Please indicate the number of people in your household (include all of your children as household members) *
Required
Please share the combined annual income for all people in the household (include all income sources  before taxes.)
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