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Household Member Details
| Name | [A. Name] | Prepares Meals with (Head of) Household | |||
|---|---|---|---|---|---|
| Citizenship Status | Disabled | ||||
| Student | Graduation Date |
| |||
| Pregnant | Due Date |
| |||
| Migrant Farmworker | Applied for S.S.N. | ||||
| Veteran Status |
Ethnic Details
| Black Or African American | Native Hawaiian Or Pacific Islander | ||
|---|---|---|---|
| Native Alaskan Or American Indian | White Or Caucasian | ||
| Asian |