Federal Funds FRL Eligibility Form

Please take sometime provide information about your household size and income estimate for our Federal Funds FRL Eligibility Survey.

The purpose of this survey is to collect data that will be used to determine the Title I funds available to Statsboro STEAM. The information you provide below is confidential. To complete the survey, find your family size, note the annual income levels and check the last column that applies to your family:

Student First Name *

Student Last Name *

Grade Level *

Student First Name

Student Last Name

Grade Level

Please select your household size. *

Please choose your annual household income. *

Is your family eligible for food stamps? *

Yes

No

Are you receiving Temporary Assistance to Needy Families (TANF)? *

Yes

No

Is your student a foster child? *

Yes

No

What is your CASE no. (SNAP)? *

What is your CASE no. (TANF)? *

Although the Statesboro STEAM does not provide a formal lunch program, we are eligible for Title I funds which are based on the above information. These monies are used to help in the overall improvement of the Statesboro STEAM such as:

Improving academic achievement (i.e., tutors, supplies, books, computers, consultants)
Compliance with Professional Standards Commission (i.e., certification, professional development, substitutes)
Providing a drug-free environment (i.e., parent/teacher education, assemblies, guest speakers)

In accordance with Federal Law and U.S. Dept. of Agriculture policy, this institution is prohibited from discrimination on the basis of race, color, national origin, sex, age or disability.

I have read and understand the purpose of Title I monies and the benefits to Statesboro STEAM Academy students and staff: Statesboro STEAM Academy staff was available to answer my questions regarding this form.

Parent First Name *

Parent Last Name *

Date * +