How old is your youngest child?

- Please select - Less than 3 months old 3 to 12 months old 13 months up to 2 years old (up to 24 months) From 2 years up to 3 years old (up to 36 months) From 3 years up to 4 years old (up to 48 months) From 4 years up to 5 years old (less than 60 months) Over age 5

Are you currently receiving cash aid (or cash assistance benefits) from CalWORKs?

- Please select - Yes No

Have you applied for CalWORKs in the past 30 days?

- Please select - Yes No N/A

Was your CalWORKs application approved?

- Please select - Yes No Pending Application N/A