Transcription of APPLICATION FOR CALIFORNIA WORK OPPORTUNITY …
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APPLICATION FOR CALIFORNIA WORK OPPORTUNITY …
STATE OF CALIFORNIA - HEALTH AND HUMAN services AGENCYCALIFORNIA department OF social SERVICESAPPLICATION FOR CALIFORNIA work OPPORTUNITY ANDRESPONSIBILITY TO KIDS (CalWORKs) (Non-Needy Caretaker Relative With Relative Foster Child)INSTRUCTIONS: Fill out this form if you want cash aid for a relative fosterchild. Complete all of the questions to the left of the heavy black line andsign the Certification section. If you need more space, attach another sheetof paper. Use one form for each child. CW 2219 (5/16) REQUIRED FORM NO SUBSTITUTE PERMITTED PAGE 1 OF 3 COUNTY USE ONLY1. Caretaker Relative s NameAddressPhone( )2. Give us all the facts for this s Name (First, Middle, Last)AddressBirthdate (Month, Day, Year) social Security Number Citizen/Noncitizen Status Citizen/National Noncitizen:Sponsored Yes NoRelationship of Child to the Caretaker Is the child pregnant or a teen parent? Yes NoIf YES , check status: Pregnant Teen Parent SCHOOL STATUS: Has a High School Diploma Has a GED Currently Attending School Not attending school (explain): _____ Other (explain): _____B.
state of california - health and human services agency california department of social services application for california work opportunity and
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