Shiloh Village School District #85 - Impact Aid Survey
Dear Parent(s)/Guardian(s),

The Shiloh Village School District #85 is eligible to receive funds from the Federal Government under the Impact Aid Program (Title VIII of the Elementary and Secondary Education Act) which is based on information obtained through this survey.

This form is an annual, mandatory survey and needs to be completed for each student in your family. Please complete the Google survey form by Friday, January 19th, 2024.

If you have any questions, please do not hesitate to reach out to Christina Hefley, chefley@shi85.org  - Subject IMPACT AID SURVEY.

Thank you!

Email *
What is your child's LAST name? *
What is your child's FIRST name? *
Student's Date of Birth (MM/DD/YYYY) *
Student's Address  (#, Street, City, Zip Code) No P.O. Boxes *
Student Grade *
Civilian - Employed on which Federal Property? *
Name of Federal Property in Illinois Not Listed (skip if does not apply to you)
Civilian - Employed on Federal Property - Parent/Guardian LAST Name - put n/a if you answered none to the above question. *
Civilian - Employed on Federal Property - Parent/Guardian FIRST Name - put n/a if you answered none to the above question. *
Uniformed Services - Branch of Service *
Uniformed Services - RANK - put n/a if you answered none to the previous question. *
Uniformed Services - Parent/Guardian LAST Name - put n/a if you answered none to the above question. *
Uniformed Services - Parent/Guardian FIRST Name - put n/a if you answered none to the above question. *
By completing this box, I am certifying that all information on this form is accurate and complete as of the survey date.  (LAST Name, FIRST name of person completing this form.) *
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