Household Income Survey

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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.

This form collects supplemental information used to determine eligibility for Wonder Years. In order to be considered for Wonder Years or LEAD Academy, please complete the Early Childhood Interest Form.

Email *

What is your child's full name? *

What is your full name? *

Do any household members currently participate in the following assistance programs: SNAP, TANF or FDPIR? *

Yes

How many persons, adults and children, live in your home? *

Please list the approximate MONTHLY total work earnings for all adults in the home. *

Please list the approximate MONTHLY income for all adults in the home from Child Support, Alimony, or Public Assistance.

Please list the approximate MONTHLY income for all adults in the home from pensions, retirement, or any other income.

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