Miami-Dade County Public Schools (M-DCPS) Division of Student and Family Support Programs Project UP-START 2025-2026 Project UP-START Student Eligibility Questionnaire

Miami-Dade County Public Schools (M-DCPS) Division of Student and Family Support Programs Project UP-START 2025-2026 Project UP-START Student Eligibility Questionnaire
The purpose of this questionnaire is to help identify school-aged children and youth who are experiencing housing instability. This includes students living in a shelter facility, sharing home of a family member or friend, living in a car, park, a hotel/motel/Airbnb. M-DCPS implements the provisions of the McKinney-Vento Homeless Assistance Act by ensuring the school stability of eligible students and providing services and resources through the Project UP-START Program. Florida Statute 837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree.

Project UP-START Services are confidential and this form is not to be shared with outside agencies.
Shelter (A)Sharing the home of others/ Doubled-up (B)Hotel/Motel/Airbnb (E)Car/Park/Trailer/Substandard Housing (e.g., no water, no electricity, mold infestation) [D]Rent homeOwn home
**If you select “Rent Home” or “Own Home,” please skip directly to Question #7.
Pandemic (P)Hurricane (H)Flooding (F)Lack of affordable housing/eviction, domestic violence, mental illness, unemployment, etc. (N)Parent/CaregiverMan-Made Disaster (D)Mortgage Foreclosure (M)Tropical Storm (S)Tornado (T)Wildfire (W)Unknown (U)

QUESTION 3: WHAT ARE THE NAMES, BIRTHDATES, SCHOOLS, AND GRADES OF EACH CHILD OR YOUTH IN THE HOUSEHOLD?

No, I am not requesting services at this time.Yes, I am requesting services at this time. If "Yes" is selected, your child's school will contact you to obtain information about the specific service(s) that you are seeking for your child. Attention School Staff: Please submit a Referral for Services (FM-7404) and/or Transportation Request (FM-7405) if the family is requesting services.
5 Are you living alone without an adult?6 Are you living alone with an adult that is NOT a parent/guardian?
Caregiver's Name
Date

MonthDayYear
Date
Unaccompanied Youth Signature

Clear
Phone Number
Format: (000) 000-0000.
*Please ask your caregiver to complete the Caregiver's Authorization Form (FM-7402), and submit it with this form.
QUESTION 7: WHAT IS YOUR ADDRESS/CONTACT INFORMATION?
Current Address*
Length of time at Current Address*
Former Address
Phone Number*
Format: (000) 000-0000.
Parent Name*
Parent/Guardian Signature*

Clear
Today's Date*

MonthDayYear
Date
FOR SCHOOL/AGENCY USE ONLY
Please email the eligible forms to projectupstart@dadeschools.net and send the ineligible forms via School Mail to the respective location site, to the attention of Project UP-START: South - Loc #7021; Central - Loc #8005, & North - Loc #9571.
School/Agency Name
Location #
School Contact Name
Position
Contact Number/Ext
Email Address
example@example.com
School / Agency Name
Location #
School Contact Name
Position
Contact Number/Ext
Email Address
example@example.com
Should be Empty:

**If you select “Rent Home” or “Own Home,” please skip directly to Question #7.