Second Home Student Interest Survey

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Who can apply for Second Home?
Any Gresham-Barlow School District student who is attending high school or the equivalent with the intent to graduate and who is 16 years old or older. If you need housing contact your school counselor or complete this form.

Email *

Student ID *

Student Name *

Student Phone Number *

School Name *

Where are you staying at night? *

My parent or legal guardian's home

A friend or family members home

On the street, in a park, or a car

A different location most every night

I need emergency housing support

Other:

Required

Is there someone who might allow you to stay with them if Second Home support was available? *

Do you have health insurance *

Yes

Maybe

Do you have SNAP benefits (food assistance)? *

Yes

Are you a current smoker? *

Yes

Are you a currently using illegal drugs? *

Yes

Have you ever been convicted of a felony or misdemeanor crime? *

Yes

Do you agree to a Gresham Police background check to verify your history? *

Yes

Do you currently have contact with your parents or legal guardian? *

Yes

Other:

Who is your emergency contact? Please include their name, phone number and relationship. *

If you have access to a printer, please right mouse click and print this application to share with the school counselor. Thank you! *

A copy of your responses will be emailed to the address you provided.

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