Tit I Fòm Koleksyon Done Pou Kay 2020-2021 Title I Household Data Collection Form 2020-2021
Che Paran/Gadyen Legal:

Lekol ou a ap patisipe nan yon pwogram ki bay manje lekol ki pa koute che pou nenpot elev nan lekol la kelkeswa estati pou repa yo. Pwogram sa a rele Pwovizyon pou Elijiblite Kominote (CEP) epi se Depatman Agrikilti Etazini (USDA) ki bay li.

Kay ki gen timoun ki nan yon lekol CEP ap ranpli aplikasyon gratis ak pri-redwi ya. Sepandan, benefis sistem lekol nou an ki soti nan anpil sibvansyon ak opotinite pou fon ki baze sou lekol ki gen repa gratis ak redwi pousantaj (FARMs). Se poutet sa, nou espere ou pral ranpli fom nou tache pou kapab ede lekol ou a resevwa finansman ki adisyonel.

Nan ka ou ta dwe gen nenpot kesyon konsenan fom sa a, tanpri santi ou lib pou kontakte direkte lekol ou a oswa Biwo Tit I an nan nimewo 410-677-4563.

Mèsi.

Dear Parent/Guardian:

Your school participates in a program that provides school meals at no cost to all students in the school regardless of their meal status. This program is called Community Eligibility Provision (CEP) and is provided through the United States Department of Agriculture (USDA).

Households with children in a CEP school do not fill out the Free and Reduced-Priced Meals Benefit application. However, our school system benefits from many grants and funding opportunities based on the schools Free and Reduced Meals percentage (FARMs). Therefore, we hope you will complete the attached form to help your school receive additional funding.

Should you have any questions regarding this form, please feel free to contact your school’s principal or the Title I Office at 410-677-4563.

Thank you.
Email address *
Lis tout timoun ki nan kay la. Tanpri tape Siyati, Non Dezyèm, Premye Non. (Egzanp: Jones, Lake, Robert) Klike sou antre pou yon nouvo liy. Yon timoun pou chak liy. / List all children in the household. Please type Last Name, Middle Name, First Name. (Example: Jones, Lake, Robert) Click enter for a new line. One child per line. *
Bay dat nesans yo nan lòd timoun ki endike anwo an la. (Egzanp: 8 novanm 2008) Klike sou antre pou yon nouvo liy. Yon dat pou chak liy. / Give the birth dates in the order of the children listed above. (Example: November 8, 2008) Click enter for a new line. One date per line. *
Lekòl timoun nan ale ak nivo klas la. (Make yon bwat pou pou chak timoun.) / School attending and grade level. (Mark one box for each child.)
PreK 3
PreK 4
K
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Beaver Run
Chipman
East Salisbury
Glen Avenue
Pemberton
Pinehurst
Prince Street
West Salisbury
Esplikasyon pou detèmine "Kantite moun ki nan kay la" ak "revni anyèl nan kay la": / Directions to determine "Household Size" and "Annual Household Income":
Kimoun mwen ta dwe enkli nan "Size Kay" (Gwose kay la)?
Ou dwe gen ladan tet ou ak tout moun ki ap viv nan kay ou, ki gen rapo oswa ou pa (pa egzanp, timoun, lot fanmi, oswa zanmi) ki pataje revni ak depans yo. Si ou ap viv avek lot moun ki ekonomikman endepandan epi ki pa not pataje revni ak fanmi ou, pa enkli yo.

Kisa ki enkli nan "Revni Anyel Kayla?" Revni Anyel Kay la gen ladan sa ki annapre yo:
• Sale brit soti nan travay: Pa peye pran-kay ou. Revni Brit se kantite lajan an touche anvan taks ak lot dediksyon. Sevi ak souch peman ou pou bay enfomasyon sa yo. Si ou te pedi travay ou oswa ou te gen edtan ou oswa sale ou redwi, antre nan zewo oswa revni ou ye kounye a redwi.

• Sipo timoun, Alimoni: Mete kantite lajan chak moun ki ap viv nan kay la resevwa nan sous sa yo.

• Pansyon, Retret, Sekirite Sosyal, Revni Sekirite Siplemante (SSI), benefis Veteran (VA benefis), ak benefis andikap: Mete kantite lajan chak moun ki ap viv nan kay ou resevwa nan sous sa yo.

• Tout lot revni: Enkli konpansasyon travaye, avantaj chomaj oswa avantaj grev, kontribisyon regilye, ak nenpot lot revni. Pa enkli revni nan WIC, benefis edikasyon federal, ak peman ankouraje yo te resevwa.

• Ti kob adisyonel pou lojman milite ak Peye Konba: Mete kay baz la. Pa enkli Inisyativ Lojman Milite oswa konba.

• Peman siplemante: Mete peman siplemante selman si ou resevwa li sou yon baz regilye.

Kouman pou mwen rapote revni chak ane nan kay la pou peye chak mwa, de fwa pa mwa, chak de semen, oswa baz chak semen?
• Detemine chak sous revni nan kay la ki baze sou definisyon pi wo a ak anyel sous revni yo mande:
o Si peye chak mwa, miltipliye peye pa 12; Si peye de fwa pa mwa, miltipliye peye total pa 24;
o Si peye chak semen (chak de semen), miltipliye peye pa 26; Si peye chak semen, miltipliye total peye pa 52.

• Ajoute peye ansanm pou detemine revni total moun ki nan kay la epi tcheke bwat la akote seri a pou gwose moun ki nan kay la.

• Si gwose kay ou a depase gwose a sou tablo a, lis mezi moun ki nan kay la ak revni anyel kay la nan espas yo bay la.

Who should I include in “Household Size”?
You must include yourself and all people living in your household, related or not (for example, children, other relatives, or friends) who share income and expenses. If you live with other people who are economically independent and do not share income with your family, do not include them.

What is included in “Annual Household Income?” Annual Household Income includes the following:
• Gross earnings from work: Not your take-home pay. Gross income is the amount earned before taxes and other deductions. Use your pay stub to provide this information. If you have lost your job or had your hours or wages reduced, enter zero or your current reduced income.

• Welfare, Child Support, Alimony: Include the amount each person living in your household receives from these sources.

• Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits: Include the amount each person living in your household receives from these sources.

• All Other Income: Include worker’s compensation, unemployment or strike benefits, regular contributions, and any other income. Do not include income from WIC, federal education benefits, and foster payments received.

• Military Housing Allowances and Combat Pay: Include off-base housing allowances. Do not include Military Privatized Housing Initiative or combat pay.

• Overtime Pay: Include overtime pay ONLY if you receive it on a regular basis.

How do I report annual household income for pay received on a monthly, twice a month, every two weeks, or weekly basis?
• Determine each source of household income based on above definitions and annualize required income sources:
o If paid monthly, multiply total pay by 12; If paid twice per month, multiply total pay by 24;
o If paid bi-weekly (every two weeks), multiply total pay by 26; If paid weekly, multiply total pay by 52.

• Add pay together to determine the total annual household income and check the box next to the range for your household size.

• If your household size exceeds the size on the chart, list household size and total annual household income in the space provided.
Gwosè kay la ak tablo revni kay la / Household Size and Household Income
Kantite moun ki nan kay la: Tape pou nou anba nimewo (1 -8) pou montre gwosè kay ou. Pou kay ki pi gran pase 8, ale nan seksyon ki anba la a. / Household Size: Type below the number (1 -8) to show your household size. For households greater than 8, skip to the section below. *
Kantite moun ki nan kay la Pi gran pase 8: Tape anba gwosè kay la (9 oswa plis) ak revni total anyèl la. (Egzanp: Gwosè kay la: 9 Total revni anyèl: $ 62,500) / Household Size Greater than 8: Type below the household size (9 or more) and total annual income. (Example: Household Size: 9 Total Annual Income: $62,500)
Revni Anyèl Kay la: Chwazi lèt la, akote gwosè kay ou ki montre nivo revni fanmi ou. (Egzanp: Si gwosè kay ou se 4, chwazi sèlman D oswa L) Tape lèt ki anba la a. / Household Annual Income: Choose the letter, next to your household size that shows your family's income level. (Example: If your household size is 4, choose only D or L ) Type the letter below. *
Mwen sètifye ke enfòmasyon ke mwen bay sou fòm sa a se verite e ke mwen enkli tout revni mwen. Mwen konprann lekòl la ka resevwa lajan leta ak lajan federal ki baze sou enfòmasyon mwen bay yo e ke enfòmasyon yo kapab sijè pou revizyon. / I certify that the information provided on this form is true and that I included all income. I understand that the school may receive state and federal funds based on the information I provided and that the information could be subject to review.
Le mwen tape non mwen anba an la, mwen dako mwen siyen fòm sa a elektwonikman. / By typing my name below, I am electronically signing this form. *
Lekòl Piblik Konte Wicomico (WCPS) entèdi diskriminasyon ilegal ki baze sou ras, etnisite, koulè, zansèt, orijin nasyonal, relijyon, sitiyasyon imigrasyon, sèks, sèks, idantite seksyèl, ekspresyon sèks, oryantasyon seksyèl, sitiyasyon fanmi / paran, eta sivil, laj , andikap fizik oswa mantal, povrete ak estati sosyoekonomik, langaj, oswa lòt atribi legal oswa konstitisyonèl pwoteje oswa afilyasyon epi li bay aksè egal a Boy Scouts yo ak lòt gwoup jèn yo deziyen. Diskriminasyon mine efò kominote nou yo depi lontan yo kreye, ankouraje, ak ankouraje ekite, enklizyon, ak akseptasyon pou tout moun. / Wicomico County Public Schools (WCPS) prohibits illegal discrimination based on race, ethnicity, color, ancestry, national origin, religion, immigration status, sex, gender, gender identity, gender expression, sexual orientation, family/parental status, marital status, age, physical or mental disability, poverty and socioeconomic status, language, or other legally or constitutionally protected attributes or affiliations and provides equal access to the Boy Scouts and other designated youth groups. Discrimination undermines our community’s long-standing efforts to create, foster, and promote equity, inclusion, and acceptance for all.
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