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Elementary School Eligibility Form

Elementary School Eligibility Form

As a member of the public school systems in the State of Arizona, we qualify to receive grant money from different sources.  One of the criteria in determining how much money we can receive from the grant is through family income.  Please take a moment to review the following table to determine if your family’s current income is at or below your household size.

The definition of income is all items such as wages and salaries before deductions, and other income, such as self-employment, welfare, social security, retirement benefits, unemployment compensation, workers compensation, Aid for Dependent Children, alimony, child support, pensions, insurance or annuity payments, etc.

Indicator 1
Household Size Yearly Monthly Twice Per Month Every 2 Weeks Weekly
1 $16,744 $1,396 $698 $644 $322
2 $22,646 $1,888 $944 $871 $436
3 $28,548 $2,379 $1,190 $1,098 $549
4 $34,450 $2,871 $1,436 $1,325 $663
5 $40,352 $3,363 $1,682 $1,552 $776
6 $46,254 $3,855 $1,928 $1,779 $890
7 $52,158 $4,347 $2,174 $2,006 $1,003
8 $58,058 $4,839 $2,420 $2,233 $1,117

For Each Additional Household Member Add

 $5,902 $492 $246 $227 $114
Indicator 2
Household Size Yearly Monthly Twice per month Every 2 Weeks Weekly
1 $23,828 $1,986 $996 $917 $459

2

 $32,227 $2,626 $1,343 $1,240 $620
3 $40,626 $3,386 $1,693 $1,563 $782
4 $49,025 $4,086 $2,043 $1,886 $943
5 $57,424 $4,786 $2,393 $2,209 $1,105
6 $65,823 $5,486 $2,743 $2,532 $1,266
7 $74,222 $6,186 $3,093 $2,855 $1,428
8 $82,611 $6,886 $3,443 $3.178 $1,589
For each additional household member add $8,399 $700 $350 $324 $162
Is your family at or below the current income guidelines?*
Answer Required

Name of School - Kaleidoscope School

I certify that all the above information is true and correct.

Confirmation Email