BackPack/Power Pack Household Information
Please note there are two parts to enrollment:
1) Complete and submit this household information page
2) At the end you will be provided a unique link to enroll your child(ren) with another form -- this must be completed or we will not have the identifying information to get your child(ren) their food.

The following household questions do not have any effect on your child(ren)'s eligibility for our program. All the information provided will be anonymous and utilized by FOCP for data and grant purposes. We do not collect identifying information and your responses are confidential.
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Which of the following best describes YOUR CHILD(REN)'S racial identity? *
Required
Of the choices below, which of the following create the biggest financial hardships for your household? *
Required
Of the adults in your household, select all that apply. *
Required
What is your household's yearly income including unemployment, disability, retirement, child support, etc.? *
How many children under the age of 18 live in your household? *
How many adults live in your household? *
In addition to the BackPack Food/Power Pack program, is your child benefiting from any other food assistance programs? Please check all that apply. *
Required
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