Income Statement Leave this field blank Nombre del niño Fecha de nacimiento Nombre del padre o tutor Enrollment applications for Head Start eligibility must have proof of income attached to the application. Families who are currently unemployed, without an income, or self-employed can submit this form & additional information as their proof of income. Please explain in detail how you are supporting your family without an income by addressing the following expenses: rent/housing, food, clothes, etc. Include an explanation of unearned income (if applicable) such as savings, help from family/friends/others, child support, unemployment, ect. For self-employed individuals: please declare your gross weekly, monthly, or yearly earnings. Firma del Padre / Tutor: Comenzar a dibujar Clear Done Start over Fecha de la firma: Enviar
