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I understand that school officials may verify the information. Print Name Sign Here Date FOR DISTRICT USE ONLY Annual Income Conversion Weekly x 52 Bi-Weekly x 26 2 Times per Month x 24 Monthly x 12 Per Week Bi-Weekly 2x/Month Monthly Annually Household Size Eligibility Free Reduced Income Categorically Eligible Application Number Determining Official s Signature Denied Date 2015-2016 FAMILY ECONOMIC DATA SURVEY PARENT/GUARDIAN INSTRUCTIONS This application form will be used by the...
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