People in Your Home


Enter information about each person in your household. Enter their first and last name in each field. If there is more than one individual in the house with the same first name, enter each individual's middle initial.

Select the person's gender by choosing either male or female.

Enter the person's date of birth in the following format: MM/DD/YYYY. Use slashes (/) in the date of birth.


Program Selection

For each relative or other household member, check the kind of help each person is applying for.



Select the person's ethnicity.


To close this window and return to ConneCT without saving, click the CANCEL & EXIT button.


To save your application and return to ConneCT, click the SAVE & EXIT button.