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LMA 2020-2021 Household Income Data Collection - LMA 2020-2021 /Recopilación de Datos de Ingresos del Hogar

Please complete the form below. Required fields marked with an asterisk * / Por favor complete el siguiente formulario. Campos obligatorios marcados con un asterisco *

PART I: Fill in the following information for a student living in your household / Part I: Complete la siguiente informacion para un estudiante que vive en su hogar.

PART II: Fill in the following information for Household size and Household income / Parte II: Complete la siguiente informacion para el tamano del hogar y los ingresos del hogar.

See additional information on the first page of this form for assistance in determining your household size and annual household income / Consulte la informacion adicional en la primera pagina de este formulario para obtener ayuda para determinar el tamano de su hogar y los ingresos anuales del hogar.

Select the total number of adults and children living in your household / Seleccione el numero total de adultos y ninos que viven en su hogar.*
Answer Required

PART III: Parent or Guardian Information and Signature / PARTE III: Información del padre o tutor y firma.

I certify (promise) 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 provide and that the information could be subject to review / Certifico (prometo) que la informacion proporcionada en este formulario es verdadera y que inclui todos los ingresos. Entiendo que la escuela puede recibir fondos estatales y federales basados en la informacion que proporciono y que la informacion podría estar sujeta a revision.

The information submitted on this form is a confidential educational record and is therefore protected by all relevant federal and state privacy laws that pertain to educational records including, without limitation, the Family Educational Rights and Privacy Act of 1974 (FERPA), as amended (20 U.S.C. & 1232g; 34 CFR Part 99); Title 2, Division 4, Part 27, Chapter 6.5 of the California Education Code, beginning at Section 49060 et seq.; the California Information Practices Act (California Civil Code Section 1798 et seq.) and Article 1, Section 1 of the California Constitution.

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