HOH First Name *
HOH Last Name *
HOH Email *
Household Size * Include all family members living in the household.
HOH Employment Status * SelectEmployedUnemployedRetiredIn School
HOH ANNUAL Income: * Please enter to the nearest full dollar amount.
HOH Disabled? * SelectNoYes
Do you identify as a Female Head of Household? * SelectNoYes
Spouse / Partner First Name
Spouse / Partner Last Name
Spouse / Partner Employment Status SelectEmployedUnemployedRetiredIn School
Spouse / Partner ANNUAL Income Please enter to the nearest full dollar amount.
Additional Family Member 18 Years or Older Living in Household - First Name
Additional Family Member 18 Years or Older Living in Household - Last Name
Additional Family Member 18 Years or Older Living in Household - ANNUAL Income Please enter to the nearest full dollar amount.
2nd Additional Family Member 18 Years or Older Living in Household - First Name
2nd Additional Family Member 18 Years or Older Living in Household - Last Name
2nd Additional Family Member 18 Years or Older - ANNUAL Income Please enter to the nearest full dollar amount.
3rd Additional Family Member 18 Years or Older Living in Household - First Name
3rd Additional Family Member 18 Years or Older Living in Household - Last Name
3rd Additional Family Member 18 Years or Older - ANNUAL Income Please enter to the nearest full dollar amount.
Childrens' First Name Last Name Age Not Enrolled in IUSD School Please enter each Child's First Name, Last Name, and Age not Enrolled in IUSD School
Street Address *
City *
Zip Code *
Contact Phone # *
Homeless? * SelectNoYes
Racial Background * SelectWhiteBlack African AmericanAsianAmerican Indian/Alaskan NativeNative Hawaiian/Pacific IslanderAmerican Indian/American Native & WhiteAmerican Indian/American Native & BlackAsian & WhiteBlack & WhiteOther Multi Racial
Ethnicity * SelectNon-HispanicHispanic
Child First Name *
Child Last Name *
Select Child's School * Select a SchoolAlderwoodBeacon ParkBonita CanyonBrywoodCadence ParkCanyon ViewCollege ParkCreeksideCulverdaleCypress VillageDeerfieldEastshoreEastwoodECLCGreentreeIrvine H.S.Irvine Virtual Academy ElementaryIrvine Virtual Academy SecondaryJeffrey Trail M.S.Lakeside M.S.Loma RidgeMeadow ParkNorthwood Elem.Northwood H.S.Not Enrolled IUSD SchoolNot School AgeOak CreekPlaza VistaPortola High SchoolPortola SpringsRancho San Joaquin M.S.San JoaquinSantiago Hills Elem.Sierra Vista M.S.Solis ParkSouthlake M.S.SpringbrookStone CreekStonegate Elem.Turtle Rock Elem.University DHH H.S.University H.S.University ParkVenadoVenado DHH M.S.Vista Verde M.S.Westpark Elem.Woodbridge H.S.Woodbury
18 Years or Older? * SelectNoYes
Grade * SelectPre-KK1st2nd3rd4th5th6th7th8th9th10th11th12thToddler
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