FIT Application

School Name*
Head of Household Data
Name*
First Middle Last
Address*
Street Address City State ZIP Code
Home Phone
Cell Phone
Email
Household Composition Data
(Includes everyone living at the same address)
Name*
First Last
Sex*
- Male
- Female
Birthdate
Month
Day
Year
Relationship
Race
Grade
School
Home Phone
Cell Phone

Household Member

Name*

First Last

Sex*

Male
Female

Birthdate

Month

Day

Year

Relationship

Race

Grade

School

Home Phone

Cell Phone

Household Income Data

Name*

First Last

Income Type

Enter monthly amount into the appropriate field

Paycheck

TANF

Unemployment

Food Stamps

Other

Household Member

Name*

First Last

Income Type

Enter monthly amount into the appropriate field

Paycheck

TANF

Unemployment

Food Stamps

Other

If you entered any "other" income, please explain

School Related Data

Do you attend PTA meetings?*

Yes
No

Do you attend teacher's conferences?*

Yes
No

Do you attend school conferences?*

Yes
No

Is school attendence important to you?*

Yes
No

Are good grades important to you?*

Yes
No

Is high school graduation a goal for your child(ren)?*

Yes
No

Is college or vocational school a goal for your child(ren)?*

Yes
No

Do you think graduating from high school will help your child(ren) get a better job and thus improve his/her life?*

Yes
No

Do you think graduation from college will help your child(ren) get a better job and thus improve his/her life?*

Yes
No

Has your child(ren) been held back a grade at any time?*

Yes
No

When?*

Do you know in which classes your child(ren) is having trouble?*

Yes
No

Please list each class

Click the plus sign to add another class to the list