Serving Salt Lake and Tooele Counties since 1965 Follow slcaporg on Twitter
Salt Lake Community Action Program
764 South 200 West Salt Lake City, Utah 84101 (801)359-2444 (801)355-1798 (f)
Erin Trenbeath-Murray Executive Director
        Food Stamp  Worksheet
Brought to you by your friends at Crossroads Urban Center and SLCAP
Income
Hourly wage Average Hours a week
1st earner*   *
2nd earner      
Total Other  income (unearned FEP, SSI, GA, Social Security etc.) 
Enter Childrens Ages and Child Care costs per month
Child1 Age  Cost  Child2 Age  Cost 
Child3 Age  Cost  Child4 Age  Cost 
Child5 Age  Cost  Child6 Age  Cost 
Child7 Age  Cost  Child8 Age  Cost 
Child9 Age  Cost  Child10 Age Cost 
Out of Pocket Medical Costs ($35 will be taken)     Rent/Mortgage costs      
Fire Insurance (if any)     Property Tax (if any)      
Utility Costs Use $229 unless there are no out of pocket costs   Total # people in household*
Child Support Costs  Elderly or Disabled Person in household 
* Required field
Utah Online Food Stamp Application
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