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Student Residency Questionnaire

Required

 

 

Name of Studentrequired
First Name
Middle (optional)
Last Name
Sexrequired
Must contain a date in M/D/YYYY format

This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to this residency information help determine the services the student may be eligible to recieve.

Is your current address a temporary living arrangement?required
Is this temporary living arrangement due to loss of housing or economic hardship?required

If you answered YES to the above questions, please complete the remainder of this form. If you answered NO, you may stop here.

Where is the student presently living (Choose one)
Name of Parent(s)/Legal Guardian(s)required
First Name
Middle (optional)
Last Name
Please include street address, city, state, and zip code.

Presenting a false record or falsifying records is an offence under Section 37.10, Penal Code, and enrollment of the child under false documents subjects the person to liability or other cost.

By typing your name in the box above and selecting "submit" you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this agreement.required
First Name
Middle (optional)
Last Name
Must contain a date in M/D/YYYY format