• FAMILY CENTER REGISTRATION FORM

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  • Important Note:

    Most of the organizations that provide funding for our programs require us to report on race and average income levels of the people who use our programs. Your information will not be shared in connection with your name—it will only be shared in the form of summaries about the people we serve.

     

    Please complete the tables and sign below to verify the information you are providing. Thank you.

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  • Annual Household Income:

    Please find the number of people in your household, then move across and check your income in that row.

  • 1 Person

     0 – $19,140 yr. 

    $368/wk.

    $19,141 yr. $25,520 yr.

    $369/wk. — $490/wk.

    $25,521 yr. $38,280 yr.

     $491/wk. — $736/wk. 

    Over $38, 281 yr.

    Over $737/wk.

    2 People

     0 - $25,860 yr.

    $497/wk.

    $25,861 yr. $34,480 yr.

    $498/wk. — $663/wk. 

     $34,481 yr. $51,720 yr.

    $664/wk. — $995/wk.

    Over $51,721yr.

    Over $996/wk.

    3 People 

    0 - $32,580 yr.

     $627/wk.

    $32,581 yr. $43,440 yr.

    $628/wk. — $835/wk. 

    $43,441 yr. $65,160 yr.

    $836/wk. — $1,253/wk. 

    Over $65,161 yr.

    Over $1,254/wk.

    4 People 

     0 - $39,300 yr.

    $755/wk.

    $39,301 yr. $52,400 yr.

    $756/wk. — $1007/wk. 

    $52,401 yr. $78,600 yr.

     $1008/wk. — $1,511/wk.

    Over $78,601 yr.

    Over $1,512/wk.

    5 People 

    0 - 46,020 yr.

    $885/wk. 

    $46,021 yr. $61,360 yr.

    $886/wk. — $1,180/wk. 

    $61,361 yr. $92,040 yr.

    $1,181/wk. — $1,770/wk. 

    Over $92,041 yr.

    Over $1,771/wk.

    6 People

    0 - $52,740 yr. 

    $1014/wk.

    $52,741 yr. $70,320 yr.

    $1015/wk. — $1,352/wk. 

    $70,321 yr. $105,480 yr.

    $1,353/wk. — $2,028/wk.

    Over $105,481 yr.

    Over $2,029/wk.

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  • Revised May 2020

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