YAYOE Family Income Eligibility Survey

Family Income Eligibility Survey 2025-2026

Even if your income does not meet these Income Eligibility Guidelines, you must return the survey in order for the survey to be valid. Information collected in this survey will remain strictly confidential.
Family last name*
Address*

Street Address

Street Address Line 2

CityState

Zip Code

Children attending Yeshiva Aharon Yaakov Ohr Eliyahu
How many of your children are currently enrolled at Yeshiva Aharon Yaakov Ohr Eliyahu?*
Initial of Child 1 First Name*
Child 1 Grade*
Child 1 Date of Birth*

MonthDayYear
Initial of Child 2 First Name
Child 2 Grade
Child 2 Date of Birth

MonthDayYear
Initial of Child 3 First Name
Child 3 Grade
Child 3 Date of Birth

MonthDayYear
Initial of Child 4 First Name
Child 4 Grade
Child 4 Date of Birth

MonthDayYear
Initial of Child 5 First Name
Child 5 Grade
Child 5 Date of Birth

MonthDayYear
I certify by clicking "Submit", under penalty of perjury, that the above responses are true and correct to the best of my knowledge and belief.
Should be Empty:

Household Size	Annual	Monthly	Twice Per Month	Every Two Weeks	Weekly
{Household}	{annual}	{monthly}	{twiceMonth}	{2Weeks}	{weekly}

Rows	Yes	No
Are your children eligible for free or reduced lunches, breakfasts, snacks or milk at their school(s)?
Is your family eligible for food stamps (SNAP/CalFresh)?
Does your family qualify for medical assistance under Medicaid (Medi-Cal)?
Is your family receiving Supplementary Security Income (SSI)?
Does your family receive assistance under CalWORKs?
Does your family receive housing assistance (section 8)?
Does your family receive home energy assistance (LIHEAP)?

Family Income Eligibility Survey 2025-2026