Skip to form

1200 First Street, NE

Washington, DC 20002

202-480-0869

Document Signers
    • 1 Parent\Guardian

SeamlessDocs




Dear Parents and Families,

The Impact Aid law provides assistance to local school districts like DC Public Schools to support children who live on military bases, Federal housing properties, and those who have parents in the uniformed services or are employed on eligible Federal properties who do not live on Federal property. Each year DC Public Schools asks all families to complete a Student-Parent Survey to support DCPS in providing information to the U.S. Department of Education for Impact Aid. The U.S. Department of Education then provides funds to DCPS to support our students based on this information. For each DCPS student in your home, please complete, sign, date, and return the survey.

All surveys results are held strictly confidential. This information will solely be used to identify those families with federally-impacted children. We encourage you to submit all survey responses by the deadline; however, we will continue to accept forms from your schools throughout the school year. For questions, please contact Tracy Igwebuike at DCPSImpactAid@k12.dc.gov or 202-480-0869


How do I complete the survey?

Please include all the following information:
  • Signature of parent and date on or after survey date
  • Student enrollment information
  1. Name of student
  2. Date of birth of the student
  3. Name of public school and grade of the students
  4. Complete address of student (no PO Boxes)
  5. Select federal property (from drop down) on which the student resides (if applicable)
  6. If child receives IEP (Yes/No)



  • Parent employment information (MILITARY)
  • If parent with whom the student resides was on active duty in the Uniformed Services*, complete this section (* Air Force, Army, Coast Guard, Marine Corps, Navy, NOAA Corps, Public Health Service, Reserves, National Guard, Foreign Military (accredited foreign government official and a foreign military officer on the survey date))

Thank you! Divya K. Brown, MPA, Director, Federal Programs and Grants, Resource Strategy Office



1 2 0 0 F irst S T, N E | Washington , D C 20002 | T 202. 442 . 51 4 9 | F 202. 535. 2256 | www . dcps . dc. gov
Please check that you agree before continuing.
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
Signature HereClick to Sign
12/02/2021Click to Sign

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

x

Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

x

Additional Signatures Required