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Family Survey (LCFF) 2024-2025

Does your family/household participate in any of the following programs?*

Food Stamps, CalFresh, TANF, CalWorks, SNAP, Medicaid, Kin-GAP, FDPIR

Answer Required

Yes

How many people, total adults and children, live in your home/household?*

Answer Required

Please list all students in the household who attend a Robla School:*

Please list the Student's Name, Grade, and the Name of the School

Answer Required

Is Your Student a Foster Child?*

Answer Required

Yes

Please enter the total monthly income earned by all members of your household*

Include all sources of income: gross wages, aid, welfare, pension, disability, and unemployment payments

Answer Required

Print Name Here*

Answer Required

Phone Number*

Number Required

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required