Active Duty/Military Information Survey

Dear Families,

In an effort to better serve students and families, the United States Department of Education is requiring all school districts to provide information about students with family members employed by the military. Nationally, more than 2 million students are from military families. This new reporting requirement was enacted to help determine whether educational outcomes are impacted by the mobility often associated with military service.

If a family member, excluding siblings, is a member of the Armed Forces – Army, Navy, Air Force, Marine Corps, Coast Guard, or National Guard – on active duty, please complete and submit this form.
Please note: The member on active duty can include a stepparent if that stepparent lives in the home where the child spends the majority of his/her time.

Thank you.

	YES, WE DO SERVE...

1.	Name of family member on active duty:*

2.	Active duty start date:*
	mm/dd/yyyy

3.	Active duty end date:
	mm/dd/yyyy

Please enter the names of your children with their current school.

	Child's Name	Current School
Child's Name (1)
Child's Name (2)
Child's Name (3)
Child's Name (4)

Active Duty/Military Information Form