Income Verification Form

The purpose of this form is to collect family income data in order to qualify your school for federal Title I funds and services for the 2024-2025 school year. Determining the number of students who qualify for free and reduced lunches and who also resides in Title I school attendance zones, accomplishes this goal.
To determine your Annual Gross income, multiply your weekly salary by the number of weeks or months you actually worked. Add to that number all other sources of income, including child support, alimony, retirement, SSI benefits, etc. Note that for each additional family member over eight, add $9,509.00 to Annual Gross Income. Then locate your family size and look at the qualifying annual gross income level listed beside it.

Family Size Annual Gross Income
2 $36,482
3 $45,991
4 $55,500
5 $65,009
6 $74,518
7 $84,027
8 $93,536
Each additional family member add: $9,505