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Qualify By Income
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Sign Up Your Child
Contact Us
Home
Qualify By Income
Apply Now
Sign Up Your Child
Contact Us
Fill Out Our Application Below
First Name
*
Middle Initial
Last Name
*
Email Address
*
Phone Number
*
Date of Birth
*
What are the last 4 digits of your Social Security number (SSN)?
*
What is the best way to reach you?
*
Email
Text/SMS
Phone
Full Street Address
*
Check any benefit that you receive.
*
Medicaid/Medi-Cal
SNAP / CalFresh
Public Housing Assistance or Section 8
Supplemental Security Income (SSI)
Low Income Home Energy Assistance Program (LIHEAP)
Veteran and Survivors Pension Benefit
WIC
None
If you do not receive any Gov benefits, you can qualify by your income. (Max $68,725 yearly)
*
Choose Below
Yes, I would like to qualify by income
No, I recieve one of the above benefits
If you wish to qualify by income please upload a recent paystub or enter company info below.
Employer Company Name
Employer Company Address
Hourly Pay Rate?
Who were you referred by?
*
Child's Full Name
*
Child's Email Address
Child's Phone Number
Child's Date of Birth (Must Be 18 and Under)
*
What are the last 4 digits of your child's Social Security number (SSN)?
*
Submit Application
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