2019-2020 Student Housing Questionnaire (Fall Semester)

Please fill out the Student Housing Questionnaire to better assist Hernando County School District with determining eligibility for receiving additional educational services for the 2019-2020 school year. All answers will remain confidential. Thank you for your time.

Question Title

* 1. Do you rent/own your own home?

Yes IF YOU ANSWERED YES, PLEASE DO NOT CONTINUE WITH THE QUESTIONNAIRE

No IF YOU ANSWERED NO, PLEASE CONTINUE WITH QUESTIONNAIRE

Question Title

* 2. What is your current living situation?

In a motel/hotel

In a shelter

Temporarily living with another person/family due to economic hardship

Temporarily displaced due to fire, natural disaster, etc.

Unsheltered (car, park, campsite, etc.)

In a residence with inadequate facilities (no water, heat, electric, etc.)

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* 3. What is the cause of your current living situation?

Foreclosure

Eviction

Unemployment

Divorce

Natural Disaster

Other (please specify)

Question Title

* 4. How long have you been in your current living situation?

Less then 6 months

Between 6-12 months

Over 12 months

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* 5. IF YOU ARE A STUDENT - Are you alone without an adult or with an adult that is NOT a parent or legal guardian?

Yes

Question Title

* 6. Please provide your contact information below to determine if your student(s) is/are eligible to receive additional educational services.

Name *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number *