No Income Declaration Statement 21-22
declare that I am the legal parent/guardian of my child(ren).
I have/had no income due to the following: (Please select one)
I am/was in training
I am/was in school
I am/was unemployed/looking for a job
Other (please specify)
Other please explain below.
I have been supporting myself & my family as follows:
I certify that this information is true. If any part is false, my participation in this agency’s programs may be terminated and/or I may be subject to legal action.
Should be Empty: