No Income Declaration Statement
Instructions
Please complete this form if your family does not have any income. If there are two parents/guardians in the home, and both have no income, it is required that this form be completed and signed by by both.
Child(ren) Name:
*
1st Parent/Guardian Name:
*
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 program may be terminated and/or I may be subject to legal action.
1st Parent/Guardian Signature:
*
Date
*
-
Month
-
Day
Year
Date
2nd Parent/Guardian Name:
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:
2nd Parent/Guardian Signature:
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: