Faribault Public School District Families in Transition Liaison: Vonna Dinse, 507-333-6186
McKinney-Vento is federal legislation stating that students (and families) who are experiencing a period of instability with their housing may be eligible for additional educational services.
All information shared on this form is confidential and is for the sole purpose of ensuring the rights of children and youth under the McKinney-Vento act.
First Name of person completing the form
Last Name of person completing the form
Relationship to student
Best way to contact you for follow up information if needed (phone number/email address):
The following situation has been indicated (if none of these applies, you more than likely do not meet McKinney-Vento's criteria):
Living in a shelter
In a motel, hotel, or weekly rate housing
Doubled up with friends or relatives because of loss of housing or unable to afford adequate housing
Living in a car, park, campground, public space, abandoned building, substandard housing or similar situation
On the street
WIth friends or relatives because you are an unaccompanied youth (youth not in the physical custody of a parent or guardian) that also meets the above criteria
First Name of student living in situation
Last Name of student living in situation
School student is attending
Grade student is in
List of other students impacted by the same living situation:
Was a parent/guardian present?
Yes, person filling out the form is the parent/guardian
Yes, parent is aware/present
No parent present
Student is an unaccompanied youth
If parent/guardian present, what is the best way to reach them? Please include email address and/or phone number:
Additional information about the situation:
A follow up contact may be made for required signatures and/or additional information.
Never submit passwords through Google Forms.
This form was created inside of Faribault Public Schools.