Family Income Survey

2022-2023 Family Income Survey

2022-2023 Family Income Survey

Completing this survey will ensure your child’s school receives the full amount of federal and state funding and makes sure your child receives all the educational services and programs they are entitled to. Rochester School District receives certain federal and state funding (Learning Assistance Program, teacher incentives, etc.) based on the economy of our community. This Family Information Survey provides your child’s school a way to collect household information.

Data collected is confidential and used only to support accessing funding from state and federal programs.

Please complete and return this form to your child’s school or the District Office before September 19, 2022.

Part 1. ELIGIBILITY: Figure out your total household income. Then look at the income chart below. Find your household size. If your total household income is equal to or less than the amount listed for your household size, check the box.

HOUSEHOLD is defined as all persons, including parents, children, grandparents, and all people related or unrelated who live in your home and share living expenses. If you’re applying for a household with a foster child, you may include the foster child in the total household size.

HOUSEHOLD INCOME is considered to be any taxable income each household member received before taxes. This includes wages, social security, pension, unemployment, welfare, child support, alimony, and any other cash income. If including a foster child as part of the household, you must also include the foster child’s personal income. Do not count foster payments as income.

with income is equal to or lower than:
    with income is equal to or lower than:
with income is equal to or lower than:
with income is equal to or lower than:
with income is equal to or lower than:
with income is equal to or lower than:
with income is equal to or lower than:
with income is equal to or lower than:
    
 

Part 2. STUDENTS: Please fill in the following information for all children living with you that are attending school.

 

Part 3.SIGNATURE:  I certify (promise) that all information on this application is true and that all income is reported.  I understand that completing this survey will ensure my child’s school receives the full amount of federal and state funding and that school officials may verify (check) this information. 

 
 
 
 
 
 

OSPI provides equal access to all programs and services without discrimination based on sex, race, creed, religion, color, national origin, age, honorably discharged veteran or military status, sexual orientation, gender expression, gender identity, disability, or the use of a trained dog guide or service animal by a person with a disability. Questions and complaints of alleged discrimination should be directed to the Director of the Office of Equity and Civil Rights at 360-725-6162/TTY: 360-664-3631; or P.O. Box 47200, Olympia, WA 98504-7200; or [email protected].

Thank you for completing the survey!


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