CalFresh Foods Prescreen

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This survey will prescreen you for CalFresh Eligibility. If eligible someone from our CalFresh outreach team will contact you to set up an appointment to complete the application process.

First Name *

Last Name *

Email *

Are you, or someone in the household a U.S. Citizen, a person with a Green Card, or a lawful permanent resident (LPR)? *

Yes

Are you within the Gross Monthly Income Limit?
1 person in Household = Gross Monthly Income of $2,266
2 people in Household = Gross Monthly Income of $3,052
3 people in Household = Gross Monthly Income of $3,840
4 people in Household = Gross Monthly Income of $4,626
5 people in Household = Gross Monthly Income of $5,412
Note: Gross = before taxes
Household = a person living alone or a group of people living together who purchase and prepare food together. *

Yes

Do you, or anyone in the household receive the Food Distribution Program on Indian Reservations (FDPIR)? *

Yes

Are you, or anyone in the household under a Meal Plan that provides 11 or more meals a week? (ex. Campus Meal Plan) *

Yes

Are you, or anyone in the household physically/mentally unable to work and/or is receiving disability benefits from any source? *

Yes

Are you, or anyone in the household a college student per CalFresh Food guide-lines: enrolled at least half-time and between ages of 18-49 *

Yes

. Students must also meet at least one of the following: (please check all that apply *

Working and getting paid for at least 20 hours per week or a total of 80 hours per month on average

Approved (or awarded or accepted) for federal or state work study, anticipates working, and have not refused a work assignment

Receiving Cal Grant A or B, and have received a California Student Aid Commission (CSAC) TANF letter

Enrolled in a Local Program that Increases Employability (LPIE)-Also known as Career & Technical Education Programs

Exerting parental control over a dependent under the age of 6 OR between the age of 6 and 12 with no adequate childcare (as determined by the county on a case-by-case basis) OR a single parent of a dependent under the age of 12

Participating in the CalFresh Employment and Training Program (CFET) or Job Opportunities and Basic Skills (JOBS), or be a recipient of CalWORKs or Aid to Families with Dependent Children (AFDC)

None of the above

Required

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