2020 Homeless Survey

Dear Faculty & Staff,

Please take a moment to read and complete the following survey. If you do not know a student who currently is living or has lived in any of the situations described below, there is a form for you to sign in lieu of completing this survey (Please check with the office staff if you do not know where this form is posted at your school.). This information is needed for compliance with federal law and to ensure that our students are receiving all of the services to which they are entitled.

The survey will be open through March 13, 2020. Thank you in advance for your time and cooperation. Should you have any questions, please do not hesitate to contact Michele Wilder, Coordinator of the KCS Homeless Education Program, at (423) 378-2424 or mwilder@k12k.com.

Please read the following carefully and identify students who are, or have been, in any of the following situations during the 2019-20 school year. Please include pertinent information when possible.

Question Title

* 1. Faculty/Staff Member's Name

Question Title

* 2. Date

Question Title

* 3. Primary School Assignment

Palmer Center

Adams

Jackson

Jefferson

Johnson

Kennedy

Lincoln

Roosevelt

Washington

Robinson

Sevier

D-B EXCEL

Cora Cox Academy

Dobyns-Bennett

Question Title

* 4. Primary position or grade level served

Question Title

* 5. Are you aware of students at your school who temporarily live or have lived with another family (relative or friend) this school year because they had nowhere else to go (due to an economic hardship, loss of housing, or similar reason)?

Yes

No

If yes, please list students' names.

Question Title

* 6. Are you aware of students at your school who currently live or have lived in a motel or hotel this school year?

Yes

No

If yes, please list students' names.

Question Title

* 7. Are you aware of students at your school who currently stay or have stayed at a local shelter this school year (SAFE House, Safe Place program at Link House, Hope Haven Ministries for Women & Children, Salvation Army, or Family Promise (formerly the Interfaith Hospitality Network of Greater Kingsport)?

Yes

No

If yes, please list students' names.

Question Title

* 8. Are you aware of students at your school who are at risk of being evicted from their home within a week or whose home is in foreclosure?

Yes

No

If yes, please list students' names.

Question Title

* 9. Are you aware of students at your school who live in substandard conditions (i.e. homes without electricity or water for an extended period of time)?

Yes

No

If yes, please list students' names.

Question Title

* 10. Are you aware of students at your school who were thrown out of their home, ran away, or willingly left home this school year and currently live or have lived in any of the situations described above?

Yes

No

If yes, please list students' names.

If you answered "yes" to any of these questions, then you probably work with students who are eligible to receive certain services through our school system's Homeless Education Program.

Please remember that student confidentiality is paramount and only those directly involved with the student or in an administrative position should know about the student's situation.

For more information about the education rights of homeless children & youth or to access resource material, please visit the National Center for Homeless Education at https://nche.ed.gov/topics/.