School Uniform Voucher Application

Full Name

Address

City

State

Telephone Number

E-mail

Race (Statistical Purposes only)

Household Size (Adults and dependents)

Name and Ages of Children School Uniforms will be used for

Marital Status

Household Income

Your relationship to Child receiving uniforms

I do acknowledge the above information is true to the best of my ability. I understand that priority will be given to Single Parent Families and Low Income Households.