ESEA Eligibility Guidelines 20-21

Guidelines to Determine Eligible Students

The Arizona Department of Education provides the following FY 2021 Income Guidelines for determining eligibility information for federal funding associated with programs funded under the Elementary and Secondary Education Act (ESEA).
Is your family at or below the current income guidelines based on the attached ESEA Eligibility Guidelines schedule? *

Indicator 1 Indicator 2 No
Definition of Income: all items such as wages and salaries before any deductions, and other income, such as self-employment, welfare, social security, retirement benefits unemployment compensation, workers compensation, Aid for Dependent Children, alimony, child support, pensions, insurance or annuity payments, etc.
If your family qualifies, please complete the following for each enrolled student: *
I hereby certify that all of the above information is true and correct.
Parent/Guardian Signature Name Date: Date
NOTE: These survey forms should be retained by the school or LEA and kept on file for a period of 5 years.
Should be Empty:

Guidelines to Determine Eligible Students