Address Household Income (check one) Less than $24,999 $25,000 $49,999 – $50,000 - $99,999 $100,000 or more Language spoken at home Number of people living in your household including yourself Number of people living in your household over the age of 21. List details for each person in the table below. Household Members over 21 Person 1 Name (First Last) Relationship to Self 12th grade or less(no diploma) Highest Education Level GED (check one) High school diploma Some college (no degree) Associate or technical degree Bachelor’s degree Graduate degree/professional Working Full Time Current Employment Status Working Part Time one) Homemaker Looking for Employment Retired Other (please specify) Person 2
Address Household Income (check one) Less than $24,999 $25,000 – $49,999 $50,000 - $99,999 $100,000 or more Language spoken at home Number of people living in your household including yourself Number of people living in your household over the age of 21. List details for each person in the table below. Household Members over 21 Person 1 Name (First Last) Relationship to Self Highest Education Level (check one) 12th grade or less(no diploma) GED High school diploma Some college (no degree) Associate or technical degree Bachelor’s degree Graduate degree/professional Current Employment Status one) Working Full Time Working Part Time Homemaker Looking for Employment Retired Other (please specify) Person 2
2018UC%20DITLE%20Summer%20Program%20Application.docx