SY 2024-25 Continuation Form-English

PPEP TEC High School

Continuation Form SY 2024-25
Please select a location*
If you started at PPEP TEC this school year, left, and you are returning, please provide proof of address.

Cancelof
PPEP TEC HIGH SCHOOL STUDENT CONTINUATION FORM SY 2024-25
STUDENT INFORMATION
LAST
FIRST
DATE OF BIRTH

MonthDayYear
Date
Address

STREET ADDRESS

Street Address Line 2

CITYSTATE

ZIP CODE
Mailing Address if Different

MAILING ADDRESS

Street Address Line 2

CITYSTATE

ZIP CODE
EMAIL*
example@example.com
CELL PHONE
PARENT/GUARDIAN INFORMATION
WITH WHOM DOES THE CHILD CURRENTLY LIVE?
Type a question

MotherFatherSelfGroup HomeOther
NAME
RELATIONSHIP
Address

Street Address

Street Address Line 2

CITYSTATE

ZIP CODE
EMAIL
example@example.com
CELL PHONE
EMERGENCY CONTACT INFORMATION

If you do not have an emergency contact please enter the school's information.
NAME
RELATIONSHIP
CELL
HOME PHONE
WORK PHONE
EMAIL
example@example.com
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:
PARENTGUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
Exceptional Education

If you/your student does not need these resources you may stop here.
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 STUDENT SERVICES.
Is the student receiving special education services?

YesNo
Please note: PPEP TEC High School is committed to providing the best educational opportunity to every student. We ask for the above information to ensure continuity of services in keeping with that committment.
McKinney-Vento Act Eligibility

Are you or your student(s) experiencing loss of permanent housing?
Is your current address temporary? If you don't stay at this address you would have nowhere else to go.

YesNo
Is this temporary address due to economic hardship or not having a safe place to stay?

YesNo
If you answered "NO" to both questions, you may stop here. Thank you.

If you answered "Yes" to either of these questions above, please complete the remainder of this form. (You can choose more than one option)
Is the student (family)currently living in a shelter?

Yes
*Is the student (family) staying with another family, friend, or other person helping during this time of transition?

Yes
Is the student(family) currently staying or living in a hotel/motel?

Yes
**Is the student(family) unsheltered? Please look below for the definition of unsheltered.

Yes
Is the student seeking enrollment without a parent or legal guardian?

Yes
*Sharing the housing of other persons because you have nowhere else to stay, you need a safe place to live, you left due to comflict/safety, you were forced to leave

**Living in a car, park, campsite, bus/train station, abandoned building, other places not orginarily used as sleeping accommodatins OR without running water, heat/AC, mold, infestations, proper beds, bathroom, kitchen, etc.
WHAT OTHER SERVICES ARE NEEDEDDESIRED
Were you or your student referred to PPEP TEC High School by someone?

YesNo
Should be Empty:

PPEP TEC High School

PPEP TEC HIGH SCHOOL STUDENT CONTINUATION FORM SY 2024-25

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

WITH WHOM DOES THE CHILD CURRENTLY LIVE?

EMERGENCY CONTACT INFORMATION

Exceptional Education

McKinney-Vento Act Eligibility

If you answered "NO" to both questions, you may stop here. Thank you.