APPLICATION QUESTIONNAIRE

*Please note that submitting an entry does not guarantee selection for the program. All submissions will be reviewed, and only selected candidates will be contacted.

*Please be informed that the program will start on January 1, 2025

ELIGIBILITY:

Means-tested benefits

Are you or is your spouse, your parent (if you are under 21 or disabled), or your child living with you receiving any of the following benefits:
  • Medi-Cal (Medicaid)
  • Supplemental Nutrition Assistance Program (“SNAP” or formerly Food Stamps)
  • Temporary Assistance to Needy Families (TANF)
  • Supplemental Security Income (SSI)
  • Other public assistance based on income and resources

Income at or below 150% of the Federal Poverty Guidelines

My household income is at or below 150% of the Federal Poverty Guidelines, based on my household size.

Sponsor’s Household Size 150% of HHS Poverty Guidelines
1 $22,590
2 $30,660
3 $38,730
4 $46,800
5 $54,870
6 $62,940
7 $71,010
8 $79,080
Add $8,070 For each additional person