Student Residency Questionnaire 2024-2025
The answers to this housing questionnaire help in determining eligibility for services that may be provided through the federal McKinney-Vento Act, 42 U.S.C 11435. The McKinney-Vento Program provides certain rights to families who are experiencing housing transition. PLEASE ONLY COMPLETE THIS FORM IF YOU ARE EXPERIENCING HOUSING TRANSITION. Housing transition can mean that due to financial hardship, your family is living in a hotel, a home where you have a mortgage or lease but the home is bug infested or has other conditions causing it to be inadequate for living, a vehicle, shelter, or living with friends and family without a legal or valid lease. For more information on what qualifies under the McKinney-Vento Act, visit https://www.lwcharterschools.com/mckinneyvento 
Sign in to Google to save your progress. Learn more
Email *
Name of Parent(s)/ Legal Guardian(s) *
Current Student Nighttime Street Address *
Former Student Nighttime Street Address *
How long have you been at this current address? *
Phone Number and Email *
Do you or have you previously worked in agriculture, fishing, lumber, or dairy at any time during the last 3 years? *
Student Name, Gender, Date of Birth, Grade, School *
Student Name, Gender, Date of Birth, Grade, School
 *
Student Name, Gender, Date of Birth, Grade, School
Student Name, Gender, Date of Birth, Grade, School
Student Name, Gender, Date of Birth, Grade, School
Temporary living situation information- Check only ONE box that applies to your situation *
If the above do not apply, describe where the student(s) most recently spent the night.
Check only ONE box that applies to the cause of your living situation *
If the above do not apply, describe the cause of your temporary living situation
Unaccompanied Homeless Youth (UHY). The enrolling student(s) is/are: *
If the Unaccompanied Homeless Youth is not staying with a parent or legal guardian, please list the contact information of the alternate adult. (Name, phone, relationship to student)
The undersigned certifies that the information provided is accurate to the best of their knowledge. Please note that Florida Statutes 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. (Please write your name and date of completion) *
Please indicate the role of the person completing this form *
For additional information on the McKinney Vento Program and rights under the federal McKinney-Vento Act, please contact 863-456-4484 or email MVProgram@lwcharterschools.com
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Lake Wales Charter Schools.

Does this form look suspicious? Report

Google Forms