Course Registration Form

2024 Helps on the Way Registration Form

Fill out the form carefully for registration
Client Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Phone Number
E-mail
example@example.com
How Many People are in your household?
How many children (17 or younger)
Eligibility for TEFAP (USDA food) is based on the household being in need of emergency food, meeting the income guidelines below or participates in SNAP, WIC, FDPIR, CSFP or a child receives free/reduced meals at school.
Self Declaration: Based on your family size, please select your income:

1 person in household Annual/$29,160 Monthly/$2.430 Weekly/$5612 people in household Annual/$39,440 Monthly/$3,287 Weekly/$7583 people in household Annual/$49,720 Monthly/$4,143 Weekly/$9564 people in household Annual/$60,000 Monthly/$5,000 Weekly/$1,1545 people in household Annual/$70,280 Monthly/$5,257 Weekly/$1,3526 people in household Annual/$80,560 Monthly/$6,713 Weekly/$1,549For each additional person add: Annual/$10,280 Monthly/$857 Weekly/$198
By selecting "yes", you acknowledge that you have read and agree to follow the 2024 Helps on the Way Policy and Procedures.

Yes
Should be Empty:

2024 Helps on the Way Registration Form