Pre-Apply

Name *

First Name

Last Name

Phone number *

(###)

###

####

Are you currently a recipient of TEA cash assistance? *

Yes

No

Are you and/or your children a recipient of SNAP (food stamps) or Medicaid/AR Kids? *

Yes

No

Please select your annual income level *

Less than $33,975

$33,976 - $45,775

$45,7756 - $57,575

$57,576 - $69,375

$69,376 - $81,175

$81,176 - $92,975

$92,976 - $104,775

$104,776 - $116,575

More than $116,575

Are you currently enrolled in college? *

Yes

No

Are you currently employed? *

Yes

No