Editing previous response:

Please fix the highlighted areas below before submitting.

Housing Questionnaire 2024-2025

HOUSING QUESTIONNAIRE 2024-2025

2024-2025 School Year

HOUSING QUESTIONNAIRE 2024-2025

Student Last Name*

Answer Required

Student First Name, Middle Name*

Answer Required

The information provided below will help the LEA determine what services you and/or your child may be eligible to receive. This could include additional educational services through Title I, Part A and/or the federal McKinney-Vento Assistance Act. The information provided on this form will be kept confidential and only shared with the appropriate school district and site staff.

Presently, are you and/or your family living in any of the following situations?*

Answer Required

Staying in a shelter (family shelter, domestic violence shelter, youth shelter) or Federal Emergency Management Agency (FEMA) Trailer

Sharing housing with other(s) due to loss of housing, economic hardship, natural disaster, lack of adequate housing, or similar reason

Living in a car, park, campground, abandoned building, or other inadequate accomodations (i.e. lack of water, electricity, or heat)

Temporarily living in a motel or hotel due to loss og housing, economic hardsip, natural disaster, or similar reason

Living in a single-home residence that is permanent

I am a student under the age of 18 and living apart from Parent(s) or guardian:*

Answer Required

Yes

Your child or children may have the right to:

Immediate enrollment in the school they last attended (school of origin) or the local school where you are currently staying, even if you do no have all the documents normally required at the time of enrollment.
Continue to attend their school or origin, if requested by you and it is in the best interest.
Receive transportation to and from their school of origin, the same special progras, and services, if needed, as provided to all other children, including free meals and Title I.
Receive the full protections and services provided under all federal and state lawa, as is related to homeless children, youth, and their families.

Please list all children currently living with you:*

Answer Required

If you have any questions about these rights, please contact your LEA's Homeless Liaison:

Tabitha Thur - 909-475-3322 or [email protected]

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required