SY22-23 Continuation Form (ENGLISH)

PPEP TEC HIGH SCHOOL
Choose your new PPEP High School Campus *
Please select one location
STUDENT CONTINUATION FORM
SY 2022-23
STUDENT INFORMATION
LAST *
FIRST *
DATE OF BIRTH *

Month Day Year
Date
Address *

STREET ADDRESS

Street Address Line 2

City. STATE.

ZIP CODE.
Is your home address different from your mailing address?

Yes No
MAILING ADDRESS-If different from your home address.
CITY
STATE
ZIP CODE
EMAIL
example@example.com
CELL PHONE
PARENT/GUARDIAN INFORMATION
WITH WHOM DOES THE CHILD CURRENTLY LIVE? *

MOTHER FATHER SELF OTHER:
OTHER-PLEASE EXPLAIN
NAME
RELATIONSHIP
STREET ADDRESS
CITY
STATE
ZIP CODE
CELL PHONE
EMAIL
example@example.com
EMERGENCY CONTACT

Provide at least one contact if possible.
NAME *
RELATIONSHIP *
CELL PHONE
WORK PHONE
EMAIL:
We/l the undersigned hereby certify that, to the best of our/my knowledge and belief, the answers to the foregoing questions and statements made by us/me in this application are complete and accurate. We/l understand that any false information, omissions, or misrepresentation of facts may result in rejection of this application or future dismissal of the applicant Student over the age of 18 and/or Parent/Legal Guardian of this student, By signing this form. attest to be residents of the State of Arizona having already provided the school with a copy of an acceptable document that displays name and residential address or physical description of the property where this student resides:
PARENT/GUARDIAN SIGNATURE

Clear
DATE

Month Day Year
Date
STUDENT SIGNATURE *

Clear
DATE *

Month Day Year
Date
EXCEPTIONAL EDUCATION & McKinney VENTO Act ELIGIBILITY

THIS INFORMATION IS UTILIZED BY THE ARIZONA AND U.S. DEPARTMENT OF EDUCATION TO DETERMINE IF PPEP TEC HIGH SCHOOL IS ELIGIBLE FOR ADDITIONAL FUNDING FOR
IS THE STUDENT RECEIVING SPECIAL EDUCATIONAL SERVICES? *

YES NO
Please note: PPEP TEC is committed to providing the best educational opportunity to every student. We ask for the above information in order to ensure continuity of services in keeping with that committment.
IS YOUR CURRENT ADDRESS A TEMPORARY LIVING ARRANGEMENT? *

YES NO
IS YOUR TEMPORARY LIVING ARRANGEMENT DUE TO LOSS OF HOME OR ECONOMIC HARDSHIP? *

Yes No
IF YOU ANSWERED "NO" TO BOTH QUESTIONS. YOU MAY STOP HERE. THANK YOU.

IF you ANSWERED "YES" TO THE QUESTIONS ABOVE, PLEASE COMPLETE THE REMAINDER OF THIS FORM
IS THE STUDENT (FAMILY) CURRENTLY LIVING IN A SHELTER?

YES
IS THE STUDENT (FAMILY) DOUBLED UP (1) ?

Yes
IS THE STUDENT (FAMILY) CURRENTLY LIVING IN A HOTEL/MOTEL?

Yes
IS THE STUDENT (FAMILY) UNSHELTERED (2)?

Yes
IS THE STUDENT SEEKING ENROLLMENT WITHOUT PARENT OR LEGAL GUARDIAN?

Yes
WHAT OTHER SERVICES ARE NEEDED/DESIRED
EXPLANATIONS LISTED ABOVE:

(1)SHARING THE HOUSING OF OTHER PERSONS DUE TO LOSS OF HOUSING, ECONOMIC HARDSHIP, OR SIMILAR REASON

(2)LIVING IN A CAR, PARK, CAMPSITE, BUS/TRAIN STATION. ABANDONED BUILDING OR OTHER LOCATIONS NOT ORDINARILY USED AS SLEEPING ACCOMMODATIONS
Should be Empty:

PPEP TEC HIGH SCHOOL

STUDENT CONTINUATION FORM

SY 2022-23

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT