Statement of Income | Washington Parish Early Childhood Network

This form must be completed by any adult household members who are claiming\ zero income of any kind.

I, have not had any income for the past months.

I am (Please check all that apply)

Unemployed Stay at-home parent or guardian Retired without a pension Student Other

I certify that the above information which I have provided regarding my income is true and that any false statements or misrepresentation could affect the eligibility of my child to participate in a publicly-funded early childhood program.

Washington Parish Early Childhood Network

Application

STATEMENT OF NO INCOME

From acorn to oak, we are growing our future!