CHILDREN INFORMATION All Households Complete Sample Clauses

CHILDREN INFORMATION All Households Complete. This Section. Enter all children's personal (earned) gross income, by amount, and how often received by placing a circle around the correct Income Codes: W=Weekly, E=Every 2 Weeks, T=Twice a Month, M=Monthly, Y=Yearly. Racial and Ethnic Identities (optional) 1. Circle one Ethnic Identity: N=Not Hispanic/Latino or H=Hispanic/Latino 2. Circle one or more racial identities: (Regardless of ethnicity) A=Asian, W=White, B=Black or African American, I=American Native or Alsaka Native, P=Native Hawaiian or other Pacific Islander LAST NAME, FIRST NAME SCHOOL (Write "NONE" if not in school) GRADE Date of Birth (Optional) Racial and Ethnic Identities: (Optional) MARK "X" If Xxxxxx Child Mark "X" if No Income Child's Personal Earned Income Source of Income (Work)? Paid How Often? (Circle) ENTER Benefit Type: CalFresh, CalWORKs, Kin-GAP, FDPIR ENTER Benefit Case Number Circle One Ethnic Identity Circle one or more ① N OR H A W B I P ❑ $ W E T M Y ② N OR H A W B I P ❑ $ W E T M Y ③ N OR H A W B I P ❑ $ W E T M Y ④ N OR H A W B I P ❑ $ W E T M Y ⑤ N OR H A W B I P ❑ $ W E T M Y If the child you are applying for is Homeless, Migrant, or Runaway, contact the school and CIRCLE appropriate letter: H M R Households submitting an application with a Benefit Case Number for CalFresh/CalWORKs for EACH child or an Adult household member, please skip to Section C and complete. A Xxxxxx Child that is under the legal responsibility of a xxxxxx care agency or court, is eligible for free meals. This eligiblity is not extended to non-xxxxxx children in the household.
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