Help Us Identify Homeless Students

Help Us Identify Homeless Students

Your answers will help determine if the student meets eligibility requirements for services under the McKinney-Vento Act.
Student Name

First NameLast Name
Parent/Guardian

First NameLast Name
School Attending
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this address Temporary or Permanent?

TemporaryPermanent
Please choose which of the following situations the student currently resides in (you can choose more than one):

House or apartment with parent or guardianMotel, car, or campsiteShelter or other temporary housingWith friends or family members (other than or in addition to parent/guardian)
If you are living in shared housing, please check all of the following reasons that apply:

Loss of housingEconomic situationTemporarily waiting for house or apartmentProvide care for a family memberLiving with boyfriend/girlfriendLoss of employmentParent/Guardian is deployedOther
Are you a student under the age of 18 and living apart from your parents or guardians?

YesNo
Housing and Educational Rights

Students without fixed, regular, and adequate nighttime residences have the following rights:

1) Immediate enrollment in the school they last attended or the local school where they are currently staying even if they do not have all of the documents normally required at the time of enrollment without fear of being separated or treated differently due to their housing situations;

2) Transportation to the school of origin for the regular school day;

3) Access to free meals, Title I and other educational programs, and transportation to extra-curricular activities to the same extent that it is offered to other students.

Any questions about these rights can be directed to the local McKinney-Vento liaison Matthew Nuttall at [765-431-7593] or the State Coordinator Gina Woodward at [(317)-232-9189].
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