Migrant_Survey

Tennessee Migrant Education Program - Occupational Survey

Your child may qualify to receive free educational services. Please answer the following questions to help us determine their eligibility. Once completed, return this form to the school.

Name

STUDENT FIRST NAMESTUDENT LAST NAME

DATE

Date

SCHOOL

GRADE

PARENT or GUARDIAN

1.) In the past three years, have your children moved to another city, state, and/or country?

YesNoOther

2.) Do you or anyone in your immediate family currently work or have worked (in the past three years) in any of the following occupations?

YesNo

If YES (Select all that apply)

Processing & Packing (fruit, vegetables, chicken, eggs, pork, beef, etcAgriculture/Field Work (planting, picking. and sorting crops; soit preparation; irrigation; fumigation; etcDairy/Cattle Raising (feeding, milking, rounding up, etc.Nursery/Greenhouse (planting, potting, pruning, watering, etcForestry (soll preparation, planting, growing, cutting trees, etcFishing/Fish Processing (catching, sorting, packing, transporting fish, etc

WEEKS

MONTHS

YEARS

HOME ADDRESS

CITY

STATE

ZIP

TELEPHONE (WITH AREA code)

For school use only: If questions 1 and 2 are "yes," please send the survey to your district migrant liaison. If you have questions, call (931)212-9539 to speak with the Tennessee Migrant Education Program. Enrollment Date: Student State ID: School District:

School District

Student State ID

Enrollment Date

Date