Financial Information Form
After School 2024-2025
Parent/Guardian Information
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Secondary Parent/ Guardian/Spouse (if applicable)
First Name
Last Name
Child 1
*
First Name
Last Name
Child 2
First Name
Last Name
Child 3
First Name
Last Name
Child 4
First Name
Last Name
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Household Information
Number of people in household including (adults and children)
*
Combined Annual household (Select One)
Please Select
$0-$25,000
$25,001-$50,000
$50,001-$75,000
$75,001- Above
Include the income of both adults
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Income Verification:
Browse Files
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Choose a file
Please attach proof of income (most recent 2 pay stubs, 2023 Tax return, or benefits letter)
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Additional Information: Please share other financial or household factors that should be considered (e.g., medical expenses, job loss, etc.)
Signature
Date
-
Month
-
Day
Year
Date
Submit
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