21-22 Ponder ISD Socioeconomic Information Form- Please fill out one form per student.
Ponder Independent School District is required to collect and report the socioeconomic status of each student to the Texas Education Agency for purposes of the annual state accountability ratings and for federal reporting. Please note that this form is not sent to the Texas Education Agency and that the income levels indicated for your family are not reported to the Texas Education Agency. Only the Economic Disadvantaged status of each student as determined by the information provided is reported to the Texas Education Agency.
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Student's Legal Last Name *
Student's Legal First Name *
Student's Date of Birth *
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Student's Campus *
Student's Grade *
SECTION A
Does your household receive Supplemental Nutrition Assistance (SNAP)? *
Does your household receive Temporary Assistance to Needy Families (TANF)? *
SECTION B
Complete ONLY if all answers in SECTION A are NO
How many members are in the household (include all adults and children)? *
TOTAL YEARLY INCOME BEFORE DEDUCTIONS OF ALL HOUSEHOLD MEMBERS:
Include wages, salary, welfare payments, child support, alimony, pensions, Social Security, worker's compensation, unemployment and all other sources of income (before any type of deductions). Effective from July 1, 2021 to June 30, 2022.
Choose total yearly income below: *
SIGNATURE
I certify that all the information on this form is true and that all income is reported. I understand the school will receive federal funds and will be rated for accountability based on the information I provide. *Must be signed and dated after 7/1/2021.
Please note that by typing your name below, your electronic signature will be filed, acknowledging that you have read all of the above information and all of the documented information is accurate. *
Today's Date: *
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