Workshop Fee Reduction Qualification Form

Household Size

Please select the number of people in your household. Household means all persons who occupy a housing unit. Occupants may be a single family, one person living alone, two or more families living together, or any other group of related or unrelated persons who share living arrangements. The incomes of all persons over the age of 18 in the household are considered when determining eligibility.
Household Size*

Adjusted Household Income

Please select the total ADJUSTED household income for the last calendar year. Select the number that best describes the income for the household without going over.
Adjusted Household Income - 1 Person*
Adjusted Household Income - 2 Person*
Adjusted Household Income - 3 Person*
Adjusted Household Income - 4 Person*
Adjusted Household Income - 5 Person*
Adjusted Household Income - 6 Person*
Adjusted Household Income - 7 Person*
Adjusted Household Income - 8 Person*

You qualify for a fee reduction waiver for this program!

We hope you'll join us. Complete the information below to submit your registration. Once you submit, we will confirm your information and registration for the program, usually within 24 business hours from your submission. DO NOT register through the Lifelong Learning website. In our confirmation, we will confirm what price the workshop will be for you.
Which program would you like to register for?*

Reclaimed Wood Picture Frame: November 1 & 8Build a Reclaimed Flip Down Coat Rack: November 13 & 20Build a Bat House: December 6, 11, and 13Build a Native (Mason) Bee Box: December 18Build a Cribbage Board: December 20
Name*

First NameLast Name
Child Name*

Child First NameChild Last Name
Child Age
Must be between 10 and 17 years old
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Demographic Information

Required for grant purposes

Ethnicity*

Yes (# of People) No (# of People

Hispanic
Today's Date

MonthDayYear
Date
Signature*

Clear
Unfortunately, you don't qualify for a fee waiver.

Thanks for filling out this information. Unfortunately you don't currently qualifiy for a fee waiver for this program. We hope you'll consider still joining, or please reach out to michael@homeresource.org with any questions.

Please leave us your name and email and we will add you to our email list!
Name

First NameLast Name
Email
example@example.com
Should be Empty:

	# of people in your household for each that apply
Single, non-elderly
Single parent
Elderly
Female head of household
Two parents
Other

	# of people in your household for each that apply
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Other

Household Size