Housing Information Forms

Missing Documents Form
Student First and Last Name*
Name of Person Completing Form*
First and Last Name
Relationship to Student*
If you are filling out about yourself, type Self
School District/Building
Proof of ResidencyProof of GuardianshipProof of IdentityBirth CertificateImmunization RecordsSchool Physical/Health RecordsSchool RecordsOther
You are being asked to answer the following questions because you are unable to provide the enrollment documents checked above that are required for enrollment. In accordance with the McKinney-Vento Homeless Assistance Act, states and localities are required to address barriers to the enrollment of students meeting the definition of homeless. Your completion of this information will facilitate the enrollment of your child (or of your own enrollment if you are an unaccompanied homeless youth)
Please list the age, date of birth, and birthplace of the students being enrolled.*
If the person completing this form is someone other that the parents, legal guardians, or other persons with legal custody of the student(s) being enrolled, please list the names of the parents, legal guardians, or custodians. (If you are an unaccompanied youth, please list your parents, legal guardians, or other adults who help take care of you, such as relatives, caregivers, social workers, etc.)
Do you have legal custody imposed by a court order or have you been designated as a court appointed guardian for the student(s) being enrolled?*
Yes or No. If yes, please explain
What court entered such order and what type of case was it (e.g., custody hearing, etc.?)
Why are you unable to present a copy of the checked items?*
In order to help the school district locate missing information for each of the students enrolling, please give the following information:
Last School Attended (Name of school, city or county, and state):*
Clinic or medical facility where immunizations or medical treatment was received (Name of facility, city or county, and state):*
If unsure. type Unsure
Signature of Person Completing Form

Clear
Date

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Date
Should be Empty:

Housing Information Forms

Missing Documents Form