Migrant Education Program Questionnaire
Parent or Guardian's Name *
Your answer
Phone or Cell Number *
Your answer
Email Address
Your answer
Physical Address *
Your answer
PO Box # Address *
Your answer
Has your family (or part of your family) traveled from your home to another location for subsistence activities this spring, summer, or fall? (If yes, please complete the rest of the questionnaire.) *
When was the last time you traveled?
MM
/
DD
/
YYYY
Where did you travel to and from?
Your answer
Was your child (or children) in your household away from home for at least one night at a time, for a total of 7 nights, all within in year?
Please list all children in your household who are younger than 20 years old.
Your answer
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