* PARTICIPANT INFORMATION: Fill out information about the child applying to the program *
FAMILY INFORMATION: Fill out information about parents/guardians and family
Please only fill out this section if the second parent/guardian LIVES with the child.
* ADDITIONAL MEMBERS - who live in the household, are supported by the parent/guardian's income, AND are related to the parent/guardian by blood, marriage, or adoption *
PLEASE SIGN HERE to verify that you have completed this application and provided true information.