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Student Housing Questionnaire

Required

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Student Housing Questionnaire

The answers to the following questions can help determine the services this student may be eligible to receive under the McKinney-Vento Act 42 U.S.C.11435.
The McKinney-Vento Act provides services and supports for children and youth experiencing homelessness.
I am filling out this form for the _______ school year:required
I am filling out this form for the _______ school year:
I am filling out this form for the _______ school year:required
Select the situation that applies to you.
Select all that applies.required
Please check all that apply below.required
Name of Studentrequired
First Name
Middle (optional)
Last Name
Multiple Choicerequired
Must contain a date in M/D/YYYY format
The student(s) named above have younger siblings/children (not yet school age) who are in need of developmental screening, community support, or referrals to early childhood services. The school counselor may be able to assist you with age-appropriate resources.