Student/Family Residence Questionnaire

Your child may be eligible for additional educational services through Title I Part A, Title I Part C-Migrant, and/or Title X, the federal McKinney-Vento Homeless Assistance Act. Eligibility can be determined by completing the questionnaire below.

Your children have the right to:

  • Continue to attend school in the school attended before you became homeless (school of origin).
  • Receive transportation to the school of origin
  • Enroll in school without giving a permanent address and attend classes while the school arranges for a school transfer, immunization records or other documents required for enrollment.
  • Receive the same special programs and services, if needed, as provided to all other children served in these programs.
  • Have enrollment disputes quickly addressed.

The McKinney-Vento Homeless Education Assistance Act ensures the educational rights outlined above for students who are experiencing homelessness. If you wish to have a copy of this document, please add an email address below and a copy of your submission will be emailed to you.

 

Presently, are you and/or your family living in any of the following situations? *
Check all that apply

If you answered "None of the above" to the previous question, you do not need to complete or submit this form. 

Please list all children currently living with you, including those not old enough for school.

Child 1
Would you like to add a second child? *
Child 2
Would you like to add a third child? *
Child 3
Would you like to add a fourth child? *
Child 4
Would you like to add a fifth child? *
Child 5

 
The undersigned parent/guardian certifies that the information provided above is accurate.

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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