2021-2022 Household Economic Survey
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Please do not complete this form if you are directly certified to receive free meals or if you have filled out a Child Nutrition Program Meal Benefits Application.
Email *
There are ____ people in my household including all children and adults. *
The total annual income for all people in the household before any deductions for taxes, insurance, medical expenses, child support, etc. is ________ per year. *
Student #1 Information: Please include the following information below: 1) Student Name, 2) School, 3) Grade, and 4) Date of Birth. *
Do you have other students? *
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