Poverty & Non-Poverty Survey for the 2022-23 School Year for IHM
Your response helps to determine the amount of Title I academic supports available to our school in 2022-2023 from the Madison Metropolitan School District (MMSD.) These supports include supplemental reading and math intervention services for eligible students.  

If children live in multiple households, only the primary household should complete this survey. Do not complete more than one survey for the same children. If your children attend more than 1 private school in Madison, you may receive multiple surveys, only complete for child(ren) attending that private school.

If a survey is completed for all eligible children, Madison private and/or parochial schools can receive the maximum Title I allocation for services allowable by law. The Title I allocation is determined by the income levels of students who would have attended a Title I school in MMSD.

For families living outside of MMSD, this information will help indicate if your children may be eligible for additional Title I supports from your home districts.

Your family name and information will be kept confidential at our school, only a summary of the data collected is provided to MMSD where it is utilized for calculating the Title I allocation for services.

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Family Last Name (To help us ensure all families have completed the survey. We will not share this information with Madison Metropolitan School District, information will be kept confidential.) *
Private School requesting this survey. *
What public school district would your child attend if they did not attend this private school? *
Is your household income at or below the amounts listed in the chart below based on the number of people permanently living in your household? *
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Does your family receive assistance through either the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF)? *
As defined by law, is your family migrant or experiencing homelessness? *
Number of children in your household that attend private school that sent you this form in kindergarten (5 on or before 9/1/2021), first or second grade. *
What MMSD public school would your child(ren) in grades kindergarten, first and/or second attend based on your address? *
Required
Number of children in your household that attend private school that sent you this form in third, fourth or fifth. *
Number of children in your household that attend private school that sent you this form in third, fourth or fifth grade? *
Required
Number of children in your household that attend the private school that sent you this form in sixth, seventh and eighth grade. *
What public school would your child(ren) in grades sixth, seventh, and/or eighth attend based on your address? *
Required
If you are unsure of your public school, enter your address here for your school to determine your home school(s). This question is not required, only if you marked unsure for your MMSD schools.
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