2025-2026 Housing Questionnaire Please enable JavaScript in your browser to complete this form.This information will be used to determine if your child qualifies for any additional assistance under the McKinney-Vento program. Eligibility can be determined by completing this questionnaire Student(s) Name(s) *Grade Level *Date of Birth *School *All other children unde age 18 living in the home Student(s) Name(s) Grade Level Date of Birth School/DistrictWhere is your child/family currently staying? *Own home or renting a single-family residence with name on rental lease.With more than one family in a house or apartment due to economic hardship.In an emergency shelter or transitional housing programIn a motelUnsheltered (i.e. car, camp site, outside, or a structure not intended for sleeping.)Housing that is inadequate (ie: no electricity, running water, etc.)In a foster care placement or group homeIf you chose emergency shelter or transitional housing program, what is the name of the program/addressIf you chose motel, what is the name of the motel/adress/room#If you chose foster care placement or group home, what is the social worker's contact infoEducation Rights of Homeless Children Immediate enrollment – Stay at school of origin if you move – Transportation support if you move – Receive full protections and services provided under all federal and state laws, as it relates to homeless chidlren. Signature * Clear Signature Relationship to child(ren) *Parents(s)Friend(s)Family RelativeAn adult who is not the legal guardianUnaccompanied YouthAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Does the address/telephone ned to be updated in our systems?YesNoSubmit
