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  • Back to School - Income

  • BACK TO SCHOOL APPLICATION - INCOME


    Income Check one:
       
       
    *   

    I * attest that my income is   *   

    I understand that each time I visit Community Action of Greene County, Inc., I will be asked if my income status has changed.

    I understand that I may be asked to provide income documentation (to include pay stubs, benefit letters, social security, child support, etc.) at a future date.

    Client Signed:   *   
    Date:  Pick a Date*   

    CAGC Staff Witness:     
    Date:   Pick a Date    

    Contact Information:
    Name:   *   *        
    Phone:    *   *   
    Email:     

    Household size:   *   
    Number of Adults:      
    Number of Children:   *   

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