Household Income Survey
Please answer the following questions regarding your total household income. IMPORTANT!! This survey IS NOT a free and reduced lunch application. If your child is placed in Wonder Years you will still be required to complete an official Free and Reduced Lunch Application for Springfield Public Schools.
Email address *
What is your child's name? *
Your answer
What is your name? *
Your answer
Do any household members currently participate in the following assistance programs: SNAP, TANF or FDPIR? *
How many persons, adults and children, live in your home? *
Your answer
Please list the approximate monthly total work earnings for all adults in the home. *
Your answer
Please list the approximate monthly total income for all adults in the home from Child Support, Alimony or Public Assistance.
Your answer
Please list the approximate monthly total income for all adults in the home from pensions, retirement or any other income.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Springfield Public Schools R12. Report Abuse - Terms of Service