We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

2022-23 Alternate LCFF Household Income Survey

Please submit this form if you did not already complete the household income form as part of the data confirmation in parent portal at the start of the current 2022-2023 school year. If you are not certain, please complete the form.

Completing this form helps ensure that your child's school receives all of the state and federal funds for which it qualifies. Thank you!

1. Please enter your student’s District student ID number (also called lunch ID):
This is the most accurate way to identify your student’s record in our student information system.

Student ID numbers are printed on report cards and visible when logged into your student’s portal account. Please click for instructions on where to locate the student ID number in English and Spanish. *This question is required. This question requires a valid number format.

2. Please enter your student’s name below.
In order to help us confirm we correctly identify your student, please enter your student’s full name as it appears on the student’s birth certificate/adoption papers.
*This question is required.

Student's first name
Student's middle name
Student's last name

3. Please enter your student's date of birth below. (MM/DD/YYYY format)
In order to help us confirm we correctly identify your student, please enter your student’s date of birth as it appears on the student’s birth certificate/adoption papers.
*This question is required. This question requires a valid date format of MM/DD/YYYY.

Student's date of birth calendar

4. At which school is your student currently enrolled? *This question is required.

5. What is your household size?

Who should I include in “Household Size”?
You must include yourself and all people living in your household, related or not (for example, children, grandparents, other relatives, or friends) who share income and expenses. If you live with other people who are economically independent (for example, who do not share income with your children, and who pay a pro-rated share of expenses), do not include them. *This question is required.

Based on your household size of 1, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Based on your household size of 2, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Based on your household size of 3, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Based on your household size of 4, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Based on your household size of 5, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Based on your household size of 6, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Based on your household size of 7, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Based on your household size of 8, select the appropriate range for total monthly household income:

What is included in “Total Monthly Household Income”?
Gross earnings from work; Welfare, Child Support, Alimony; Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits, (VA benefits), and disability benefits; Military Housing Allowances and Combat Pay; All Other Income.
Please see this page for detailed instructions. *This question is required.

Please enter your household size and total monthly income below: *This question is required.

	Household size
	Total Mostly Income (in dollars $)

6. Please enter the name of the adult household member completing this form:
This information is needed in case we need to contact you for clarification. *This question is required.

First Name

Last Name

Email Address

Phone Number

7. Do you have another student for whom you need to submit an additional survey form?
Select yes below and we will automatically redirect you to a new survey form after submission of this current form.

8. I certify (promise) that the information provided on this form is true and that I included all income. I understand that the school may receive state and federal funds based on the information I provide and that the information could be subject to review. *This question is required.

Clear

Signature of