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Get Cw 8a 2014-2024

and Request for Cash Aid and/or CalFresh) WORKER NAME AND NUMBER 2. Give us all the facts for this child. CHILD’S NAME (FIRST, MIDDLE, LAST) OTHER PARENT’S NAME SEX (✔) ■ M ■ BIRTHDATE (MONTH, DAY, YEAR) TYPE OF AID REQUESTED (✔) CITIZEN/NONCITIZEN STATUS (✔) BLIND, DEAF, OR DISABLED ■ ■ ■ CalFresh Noncitizen: Sponsored ■ ■ ■ YES YES ■ NO 4. Did the child get cash aid or CalFresh this month? If “YES”, complete below: Cash Aid YES ■ NO .

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