Title I Private Schools Family Income Survey

The information that is requested on the survey will remain at our school and is confidential.

Dear BJA Parents & Guardians:

We have the opportunity to secure additional services in reading and mathematics for our scholars. You can help by filling out the Title I Private Schools Family Income Survey.    

Please complete this confidential survey for each of your children (one survey per scholar, 2 scholars = 2 surveys, etc.)

Your survey is due no later than:
MONDAY, NOV.11TH

In order for BJA to receive additional funding to provide this needed resource, we share a school summary of the survey with your local public school system and the Maryland State Department of Education. Individual survey responses from families are not shared. Providing us with the information requested on the survey will increase or maintain the educational services provided to scholars. The information that is requested on the survey will remain at our school and is confidential.

When completing the Title I Private Schools Family Income Survey, please be sure to:

1.      Select the correct box with your county or city of residence

2.      Answer question A and B

3.      Complete section C if applicable

Respectfully,
David Turner
Principal
(410) 542-6758 office
(410) 542-7412 fax
dturner@bjacademy.org

Question Title

* 1. NAME OF SCHOLAR

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* 2. PRIVATE SCHOOL NAME

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* 3. GRADE LEVEL

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* 4. ADDRESS

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* 5. COUNTY OF RESIDENCE

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* 6. IS YOUR HOUSEHOLD HOMELESS

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* 7. DOES YOUR HOUSEHOLD RECEIVE FOOD STAMPS OR TEMPORARY CASH ASSISTANCE (TCA)?

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* 8. BALTIMORE CITY & ANNE ARUNDEL COUNTY RESIDENTS ONLY
Select family size (family size is equal to the total number of children and parents/guardians living as one economic unit).  

*Select "One" for a foster child (considered a family of one), an emancipated youth, or a special education child over the age of 16.

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* 9. BALTIMORE COUNTY, HARFORD COUNTY, HOWARD COUNTY OR OTHER COUNTY ONLY.
Select family size (family size is equal to the total number of children and parents/guardians living as one economic unit).

*Select "One" for a foster child (considered a family of one), an emancipated youth, or a special education child over the age of 16.

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* 10. IS YOUR FAMILY INCOME EQUAL OR LESS THAN THE INCOME PER YEAR? (see question 8 or 9)

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