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To qualify, families must have a child in pre-k-12th grade education and qualify for free or reduced school lunch.

First Name

Last Name

Street Address

Apt. #

City

Zip Code

Cell Number

What is your annual household income? ¿Cual es tu ingreso anual?

How many people live in your home? ¿Cuántas personas viven en su familia / hogar?

Number of children living in the home.Número de niños que viven en el hogar.

Language spoken at home. Idioma que se habla en casa.

Ethnicity. Etnicidad