The following information is required for your child to be enrolled in a program:
____ Two (2) consecutive check stubs for EACH PARENT or CAREGIVER IN THE HOUSEHOLD for the current year (within 2 months from the date of filling out this application.) Use tables in the attached Eligibility Guidelines to calculate.
____ An official letter from your employer stating all of the following:
____ SNAP/Food Stamps – must include the child’s name and valid effective dates.
____ A statement from the Social Security Administration verifying that the child listed on the application is a recipient of SSI benefits, which must be accompanied by two current check stubs.
____ Current foster care placement agreement from the Department of Children and Family Services (DCFS)
____ Any adult in the household who claims zero income of any kind must submit a Statement of No Income form. (link to the document is below)
____ Parents or guardians who are employed intermittently, self- employed, or who do not have tax forms, W-2 forms, check stubs, or applicable DCFS printouts to verify their income must submit a Declaration of Income for Irregular Employment form. (link to the document is below)
____ Families in a temporary living arrangement due to loss of housing or economic hardship (homeless).
____ Other: ______________________________________________________________________
May be subject to review.
Note for LA4 Program: 2018 tax documentation is allowable for the proof of income ONLY if no other form of income verification documentation exists. Previous tax years are not allowed.
LA4 Program: The required documents should be dropped off at the school you choose. If you have any questions contact the LA4 office at 337-537-5145.
Headstart: The required documents should be dropped off at the HeadStart office at 1409 South 4th Street, Leesville, LA 71446. 337-239-6899