Editing previous response:

Please fix the highlighted areas below before submitting.

Enrollment Residency Questionnaire

This form is intended to address the McKinney-Vento Act. Your answers will help determine residency documents and certain needs for the student.

Student First Name*

Answer required for "Student First Name"

Student Last Name*

Answer required for "Student Last Name"

Complete EITHER Section A OR Section B:

Section A: Presently, where is the student living? (select one)

Answer required for "Section A: Presently, where is the student living? (select one)"

Temporarily with more than one family (due to loss of job, loss of housing, etc.)

In a motel, car, or campsite

In a temporary foster care awaiting permanent placement

Alone without parental support (independent living student)

In a shelter

Section B: Choices in Section A do NOT apply

Answer required for "Section B: Choices in Section A do NOT apply"

YES

Continue: If you checked an option in Section A, please complete the rest of this form.

STOP: If you checked Section B, you do not need to complete the remainder of this form.

Only complete if you selected an option in Section A:

Student First Name

Answer required for "Student First Name"

Student Middle Name

Answer required for "Student Middle Name"

Student Last Name

Answer required for "Student Last Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Gender

Answer required for "Gender"

Male

Female

Parent Guardian

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Present Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Phone Number

Number Required

Last School Attended

Answer required for "Last School Attended"