CalFresh Outreach Prescreen Question Title * 1. What is your first name? Question Title * 2. What is your last name? Question Title * 3. What is your email address? Question Title * 4. Are you, or someone in the household a U.S. Citizen, a person with a Green Card, or a lawful permanent resident (LPR)? Yes No Question Title * 5. Are you within the Gross Monthly Income Limit?1 person in Household = Gross Monthly Income of $2,1282 people in Household = Gross Monthly Income of $2,8743 people in Household = Gross Monthly Income of $3,6204 people in Household = Gross Monthly Income of $4,3685 people in Household = Gross Monthly Income of $5,114Note: Gross = before taxesHousehold = a person living alone or a group of people living together who purchase and prepare food together. Yes No Question Title * 6. Do you, or anyone in the household receive the Food Distribution Program on Indian Reservations (FDPIR)? Yes No Question Title * 7. Are you, or anyone in the household under a Meal Plan that provides 11 or more meals a week? (ex. Campus Meal Plan) Yes No Question Title * 8. Are you, or anyone in the household physically/mentally unable to work and/or is receiving disability benefits from any source? Yes No Question Title * 9. Are you, or anyone in the household a college student per CalFresh Food guide-lines: enrolled at least half-time and between ages of 18-49 Yes No Question Title * 10. Students must also meet at least one of the following: (please check all that apply) TEMPORARY COVID EXEMPTION: $0 Expected Family Contribution (EFC) as listed on your Student Aid Report. TEMPORARY COVID EXEMPTION: Eligible for state or federal work study as determined by the Financial Aid Office. Working and getting paid for at least 20 hours per week or a total of 80 hours per month on average. Approved (or awarded or accepted) for federal or state work study, anticipates working, and have not refused a work assignment Receiving Cal Grant A or B, and have received a California Student Aid Commission (CSAC) TANF letter Enrolled in a state funded program that increases employability (EOPS, DSPS, CARE) Enrolled in a program that increases employability for current and former foster youth (Guardian Scholars, FYSI, CAFYES, ETV or Extended Foster Care) Exerting parental control over a dependent under the age of 6 OR between the age of 6 and 12 with no adequate childcare (as determined by the county on a case-by-case basis) OR a single parent of a dependent under the age of 12 Participating in the CalFresh Employment and Training Program (CFET) or Job Opportunities and Basic Skills (JOBS), or be a recipient of CalWORKs or Aid to Families with Dependent Children (AFDC) None of the above Done
