McKinney Vento Homeless Survey
The information provided below will help the district determine what services you and/or your child may be eligible to receive. This could include additional educational services  through Title I, Part A and/or the federal McKinney-Vento Assistance Act. The information provided on this form will be kept confidential and only shared with  appropriate school district and site staff.  

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Presently, are you and/or your family living in any of the following situations? Check all  that apply.  
Your child or children may have the right to:                     • Immediate enrollment in the school they last attended (school of origin) or the  local school where you are currently staying, even if you do not have all the  documents normally required at the time of enrollment.                                                                                       • Continue to attend their school of origin, if requested by you and it is in the best    interest.                                         • Receive transportation to and from their school of origin, the same special  programs and services, if needed, as provided to all other children, including free  meals and Title I.                                                              • Receive the full protections and services provided under all federal and state  laws, as it relates to homeless children, youth, and their families.                                                                                                                                   Please list all children currently living with you. (Name, DOB, Grade and School )
Parent/Guardian Name and Date
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