Help Us Identify Homeless Students

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?

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

If you are living in shared housing, please check all of the following reasons that apply:

Are you a student under the age of 18 and living apart from your parents or guardians?

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].