Career, Technical, Adult & Community Education
2019-2020 WORKFORCE EDUCATION REGISTRATION APPLICATION ADDENDUM
Name: Student ID:
Income Status
Please answer ALL questions related to any income barrier you feel you possess. This information is required by the Florida
Department of Education. All responses are kept secure and confidential.
1.
Will you exhaust your TANF (Temporary Assistance for Needy Families) benefit within the next two (2) years?
Yes (A)
No
Does Not Apply
2.
Have you been unemployed for the last 27 or more weeks?
Yes (B)
No
3.
Do you identify yourself as being low income? Some examples of being low income may include:
Examples For Reference ONLY
Being a member or having a member of your immediate family receiving
benefits through SNAP/TANF, SSI and/or other state public assistance.
A youth who receives free or reduced lunch in school.
Currently in a foster care program.
Being a person with disability AND a personal income at or below the
poverty line, regardless of family income.
Currently homeless.
Currently a youth who is living in high-poverty area.
Yes, one or more of the above in Question #3 apply to me (C)
No, none of the above in Question #3 apply to me
Persons in
Household
Low
Income
Guidelines
1
2
3
4
5
6
7
8
$12,490
$16,910
$21,330
$25,750
$30,170
$34,590
$39,010
$43,430
For households with more
than 8 persons, add $4,420
for each additional person
Si
nature of Student Date
IF 040 - WEIM 11/8//2019
Broward County Public Schools
The School Board of Broward County, Florida, prohibits any policy or procedure which results in discrimination on the basis of age, color, disability, gender identity, gender expression, genetic information, marital status, national
origin, race, religion, sex
or sexual orientation. The School Board also provides equal access to the Boy Scouts and other designated youth groups. Individuals who wish to file a discrimination and/or harassment complaint may call the Director,
Equal Opportunities/ADA Compliance Department & District’s Equity Coordinator/Title IX Coordinator at
754-321-2150 or Teletype Machine (TTY) 754-321-2158. Individuals with disabilities requesting accommodations under the Americans
with Disabilities Act Amendments Act of 2008, (ADAAA) may call Equal Educational Opportunities (EEO) at 754-321-2150 or Teletype Machine (TTY) 754-321-2158.
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