TCSD Homeless Children and Youth Application
Student Information
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Email *
Today's Date *
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Student's First and Last Name: *
Date of Birth: *
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Current Age: *
Current Grade: *
Sex: *
Race: *
Person completing form: *
Please answer these questions about the student’s residency.  The information you provide is confidential and protected by the law called the Federal Education Rights and Privacy Act. We use this information to decide which schools’ students should attend. We also use this information to make sure the rights of a child, youth or an unaccompanied youth are met based on a law called the McKinney-Vento Homeless Assistance Act.
Is the student’s address a temporary living arrangement? *
Is the student’s living arrangement due to loss of housing or financial hardship? *
If the answer to any of the above is YES, please complete the following:  Where is the student identified above currently living? (Please check one) *
Use the space provided below for further explanation of your situation (if needed):
Last school the student attended (name of school, district, city or county, and state): *
Name of parent, guardian, or education decision maker: *
Electronic Signature of Parent, Guardian, or Education Decision Maker *
Signature of parent, guardian, or education decision maker
Electronic Student Signature (if unaccompanied youth)
Student Signature (if unaccompanied youth that is homeless)
Mailing Address (inc. City, State, and Zip): *
Home, Work, and Cell Phone Numbers: *
Email Address:
If a child, youth or unaccompanied youth is NOT living in permanent housing, proof of residency and other documents (health, school records, etc.) normally needed for enrollment are NOT required. The child, youth or unaccompanied youth must be enrolled immediately in his or her school of origin, the school where other children attend that is in the area where the student is currently living, or another school that the student may attend based on what is best for the student.                                                                            
OFFICE USE ONLY                                                                                                                                                               Date Completed:                                                         Eligible:  Yes       No                                         District Representative:                                                                                                                                          Comments:
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