GCPS Student Residence Questionnaire
2022-2023 (2nd Semester)
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Families In Transition - Gadsden County Public Schools - 35 Martin Luther King, Jr. Blvd. - Quincy, Florida 32351

                                                   Elijah Key, Superintendent
Educating Every Student Today, Making Gadsden Stronger Tomorrow
A.      STUDENT INFORMATION
Student Name *
Gender *
Required
Date of Birth *
MM
/
DD
/
YYYY
School *
Required
Grade *
B.      PARENT/GUARDIAN INFORMATION
Name of Parent/Guardian *
Current Street Address *
City *
Zip Code *
Home Phone Number (Please indicate N/A if you do not have a home phone number.) *
Cell Phone Number (Please indicate N/A if you do not have a cell phone number.) *
Email Address *
C.      PROGRAM ELIGIBILITY
Please check all that apply
Note: If you checked Not Applicable for #4 below, you do not have to complete the remaining portion of this form. If you checked #1, #2 or #3 below, please complete the remaining portion of this form.
D.      RESIDENTIAL STATUS
If you, your child, or a child in your care have/has experienced any of the following descriptions during this school year, please enter a check mark for each that applies.
E.      CAUSE OF TEMPORARY RESIDENCE
F.     ONLY UNACCOMPANIED HOMELESS YOUTH MUST COMPLETE THIS SECTION
Unaccompanied youth are youth who are not in the physical custody of a parent or court-appointed guardian, including: Young people who have run away from home; Young people who have been forced to leave their homes; Young people whose parents have left the area and left the student here.
Student is living with an adult that is not a parent or legal guardian
Student is living alone without an adult
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