Income Determination Form 2021-2022  
2021-2022 Federal Funding School Year- Anser Charter School

This school year, all school meals are free for students. As a result, schools do not have the Free and Reduced Meals Application to determine what percentage of families in their community would qualify for free or reduced price meals. This percentage is what the State uses to set the funding Anser receives for our Title 1 and a portion of our Special Education programs. All parent/guardians of students enrolled in charter schools in Idaho will be asked to complete this form in the 2021-2022 school year. We ask that you please complete this form, in order for Anser to receive all of the funds for which it is entitled for these important programs that serve our students.

Anser will not share any personally identifiable information included in this form. This form will not be shared with the State of Idaho.  Only the percentage of families who do/do not have income that falls below those shown in the chart below in the entire school will be shared with the State.

PRIVACY ACT STATEMENT: This explains how we will use the information you give us. Various federal programs require the information on this form. You do not have to give the information, but if you do not, the listed above LEAs (Anser) may not be eligible for amounts of federal funding calculated using the data. This form uses your eligibility information to help your Charter (Anser) evaluate, fund, or determine benefits for their Federal and some other programs. All information is highly confidential and must be handled accordingly by all program officers.

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Name of a School your child(ren) is(are) attending: *
Number of children attending: *
Name of traditional public school(s)and district that serves the areas in which your child(ren) resides: *
Number of people living in the household: *
Is your family or foster child's yearly, monthly or weekly income equal to or less than the amount on the income eligibility chart? *
Please list your physical address, city, state and zip code: *
Full Legal Printed Name of Adult Household Member or Foster Parent. By printing your name you are certifying that all of the information provided is true and correct. *
Date you are signing this form *
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