McKinney-Vento Referral Form for SLSD
Children and youth experiencing homelessness face unique challenges in accessing and succeeding in school. The McKinney-Vento ("MV") Act helps remove barriers so that students can be more successful.

Please fill out this form to refer a student to the MV Program. Jade Chamness, the new MV Liaison, will meet with the student/family to determine their eligibility. If they qualify, Jade will help make sure the student can access school, and will provide the student with support navigating systems and connecting to stabilizing resources.
Email address *
Who is eligible to receive support from a McKinney-Vento Liaison?
As a general rule of thumb, if you have a suspicion that a student might not have permanent housing, please fill out this referral form. We want all eligible students to get help, so please err on the side of over referring.

Students are eligible if their housing situation isn't fixed, regular or adequate. Examples of living situations include: living in a shelter, transitional housing, a motel/hotel or substandard housing, sleeping in a vehicle, tent, RV, or public space, or staying with friends or family due to hardship. Youth who no longer live with their family and/or are living on their own may also qualify.

Thank you!
Jade Chamness

Cell: 541-735-5702 (call or text)
Email: jade.chamness@slane.k12.or.us
REFERRAL FORM
My name *
Your answer
My position *
Your answer
School that student attends *
Your answer
Student's name (first and last) *
Your answer
Student's ID number
Your answer
Student's age *
Your answer
Student's gender *
Is there anything in particular you'd like to share about the student/family housing situation?
Your answer
What might the student/family need? *
Required
Is there anything else you think I should know about the student/family situation?
Your answer
What's the best way for me to contact the student/family? (e.g. phone, email, at school) *
Your answer
Are there steps your school has taken to try to meet the needs of the student/family?
Your answer
Thank you! Jade will confirm receipt of this referral soon.
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