Housing Transitions Program

McKinney-Vento Housing Transitions Program

Shelton School District has received special grant funds to assist children who may qualify as being “homeless” or at risk of homelessness (McKinney-Vento Act). The federal government’s definition of “homelessness” includes a variety of living situations such as temporarily living with friends or relatives due to economic hardship or losing housing because of job or income loss. This questionnaire is optional and is intended to help identify students and families who may qualify for extra assistance and/or help with paying for school-related expenses. Your answers will be kept confidential.

Question Title

* 1. Are you living in a temporary living arrangement (eg; with friends or family) due to loss of housing or economic hardship?

Yes

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* 2. Are you currently under an eviction or foreclosure process?

Yes

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* 3. Are you living in substandard housing not fit for healthy human inhabitation?

Yes

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* 4. Are you living as an unaccompanied youth, without your parent or legal guardian?

Yes

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* 5. Are you living in transitional housing from a HUD shelter? In a shelter?

Yes

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* 6. The Shelton School District partners with Saint's Pantry to provide bags of food on a weekly basis to families. Would you be interested in receiving weekly support with food from your child's school?

Yes

If you answered YES to any of the above questions, please complete the remainder of the form and consider yourself eligible for McKinney/Vento services. If you answered NO to all, you may stop here.

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* 7. Where is the student(s) presently living (check all that apply)?

in substandard housing

in a shelter

in a car

in a transitional housing program

as an unaccompanied youth

in a motel

in a campground or campsite

temporarily with friends or family members

Other (please specify)

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* 8. Student Information?

Name of Student 1

Date of Birth

School attending

Grade

Gender (M/F)

Name of Student 2

Date of Birth

School attending

Grade

Gender (M/F)

Name of Student 3

Date of Birth

School attending

Grade

Gender (M/F)

Name of Student 4

Date of Birth

School attending

Grade

Gender (M/F)

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* 9. Contact Information

Name

Address where you are currently staying

City/State/Zip

Contact Phone Number

Cell/Message Phone

*Is your child/children receiving free lunch

Are you a Parent/Legal Guardians/Unaccompanied Youth (Choose One)

Thank you for filling out this important information. You can turn in this form to the receptionist at your child’s school. If you have any questions about McKinney-Vento eligibility or services,

Please Contact:

Sascha Fischel-Freeman                                                                 Ricardo Del Bosque

Family & Student Support Coordinator                                        Bilingual Family and Student Support Coordinator

Shelton School District                                                                     Shelton School District

(360) 462-2237                                                                                   (360) 490-0935

Parents/Student/Guardian – Please be assured that the information on this form will be kept completely confidential. All student information is protected under the Family Education Rights and Privacy Act of 1974, and can only be released or shared with those individuals/agencies with written consent from the student (if 18 years or older) or by the parent/guardian of the student(s).