Greenfield-Central Community School Corporation

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Greenfield-Central Community School Corporation - Residency Information Form

This questionnaire is in compliance with the McKinney-Vento Act, U.S.C.A. 42 Section 11302(a). Your answers will help the administrator determine residency documents necessary for enrollment of your student(s). Greenfield-Central sends this questionnaire to all parent(s)/guardian(s)/unattached youth twice a year in accordance with legal requirements. Please complete at your earliest convenience.

Student Name *

Parent/Guardian Name *

School Student Attends *

Phone Number *

Age *

Grade *

Date of Birth *

Address *

City *

Zip Code *

Please choose which of the following situations the student currently resides in (may choose more than one): *

Parent/guardian rents/owns house or apartment

Motel, car, or campsite

In the streets, abandoned buildings, or living in a public place

Shelter or other temporary housing

Shared housing with friends or family members (other than parent/guardian)

Waiting for foster care placement

Required

If you are living in shared housing, please check all of the following reasons that apply:

Economic situation

Temporarily waiting for house or apartment

Provide care for a family member

Living with boyfriend/girlfriend

To enable child to attend Greenfield-Central Schools

Loss of employment

Convenience

Other:

Are you a student living without your parents or guardians?

Yes

Clear selection

Residency and Educational Rights

Students who are in temporary, inadequate, and homeless living situations have the following rights:

1) Immediate enrollment in the school they last attended or the school in whose attendance area they are currently staying even if they do not have all of the documents normally required at the time of enrollment;

2) Access to free meals and textbooks, Title I and other education programs, and other comparable services including transportation;

3) To attend the same classes and activities that students in other living situations also participate in without fear of being separated or treated differently due to their housing situations.

Any questions about these rights can be directed to the McKinney-Vento Liaison, Terry Miller, at 317-462-1492 or the State Coordinator at (317) 234-4827.

By signing below, I acknowledge that I have received and understand the above rights.

Electronic Signature of Parent/Guardian/Unattached Youth *

Date *

YYYY

Submit

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