2021-2022 Household Economic Survey
Thank you for your time and consideration in completing this process. For your school to receive specific state and federal benefits and funding, please fill out this form.
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.
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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This form was created inside of Lyndon USD 421.