McKinney-Vento Program Intake Form

Title X - The Federal McKinney-Vento Act (part of NCLB) guarantees equal access to public education for students experiencing homelessness.  Title X students may be:

Sharing housing due to loss of housing or economic hardship

Living in motels, hotels, camp grounds, parks, public places or other accommodation not designed for human habitation

Living in emergency or transitional shelters

Qualified migrant children in the above living circumstances

Awaiting foster care placement

Enrolled in School *
Students Living Situation *
If Doubled Up was checked above, Did you move in with a family for mutual benefit? *
Is the living arrangement due to the loss of housing or economic hardhip? *
Is there a plan for this housing situation to remain intact long term? *
Does everyone have a bed to sleep in? *
Is the student unaccompanied by a parent/guardian? *
Check the following services that are needed or requested: *
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