Impact Aid Survey 2021-2022

Impact Aid Survey 2021- 2022

Dear Parent or Guardian:

Our school district is entitled to apply for funds from the U.S. Department of Education under Title VIII of the Elementary and Secondary Act (Impact Aid). These funds are for school districts that serve large numbers of military dependents or other federally connected children. To receive these funds, we must have a completed Parent-Pupil Survey form on each student so that federal students may be identified.

Please complete the Parent-Pupil Survey form ( for your child.  It is very important that a completed form for every student be returned to school. The information on the form will be kept confidential and is required in order to identify federally connected students. Your cooperation is of vital importance to your child, the other children we serve, and the school district.

The form is divided into several sections, and the information below may assist you in completing the form.  

SECTION I:  Please fill in all the information about your child.

SECTION II:  If the child lives on federal property, check Yes and identify the federal property and proceed to Section III. If the child does not live on federal property, check No and proceed to Section III.

SECTION III:  If the parent, step-parent, guardian, or adult with whom the child resides is on active duty in the military (anywhere in the world), check Yes and provide the parent’s name, rank, and branch of service. If the parents are divorced, and the child has a military dependent ID card, please provide the information requested for the sponsor. If the child’s parent or guardian is not on active military duty, check No.

Please electronically sign this form in the signature space provided for the parent or guardian with whom the child resides, date the form, enter the phone number within 2 days.

We must have a completed form for each student regardless of federal status.  Thank you for your cooperation in this matter.