ATTENTION: This LPS Student Residency Questionnaire MUST be the FIRST FORM a parent/guardian completes when enrolling new and returning students. How a parent completes this form determines whether enrollment documentation is required.

May 2018

McKinney-Vento Enrollment Procedure (McKinney-Vento Education Program = Homeless Education Program)

I. II.

Please discard all old LPS Enrollment Questionnaires and Resident Affidavit forms from previous years. The LPS Student Residency Questionnaire 2018/2019 needs to be the FIRST FORM of the enrollment packet. How parents complete this form determines whether enrollment documentation is required. III. Parents/guardian/unaccompanied youth need to complete and sign ONE LPS Student Residency Questionnaire 2018/2019 per student (Newly enrolling AND returning). IV. If parent/guardian/unaccompanied youth answers “YES” to any of the five questions, the remainder of the form needs to be completed. Proceed with enrollment even without the normally required documentation: The Federal McKinney-Vento Homeless Assistance Act (42 U.S.C.11434a(2) requires the immediate enrollment of children and youth experiencing homelessness, even in the absence of records normally required for enrollment, such as immunization records, proof of residency, birth certificate, proof of guardianship, or other documents. V. If the parent/guardian/unaccompanied youth checks “with more than one family in a house or apartment”, the host information has to be completed, (middle section of form marked as REQUIRED). The host family will need to present a proof of residency and sign the form. If the host family is not present, the student still must be enrolled without delay, and documentation will be completed in a timely manner after enrollment. Proceed with enrollment even without the normally required documentation. VI. If parent/guardian/unaccompanied youth answers “No” to ALL of the five questions, proceed with the usual enrollment requirements. VII. Please use the provided area on the LPS Student Residency Questionnaire 2018/2019 to check if birth certificate and shot records were presented at the time of enrollment. VIII. Please send ALL LPS Student Residency Questionnaire 2018/2019 to the Federal Programs Office. When in doubt, enroll the student immediately and contact your District Liaison with questions. Denying immediate enrollment to a homeless student violates federal law and may place the student in danger. As the advocate for Homeless and Foster Care students, I am reminding schools not to post signs stating, “Must have proof of residency, birth certificate and shot records”. This sign could be viewed as a school creating a barrier to enrollment, which is a violation of the law. *McKinney-Vento Liaison is located in Room 21A at Douglass Learning Center, ext. 2311, cell (580)678 4516

Student Residency Questionnaire 2018-2019 PLEASE PRINT CLEARLY

Student Name:

Date of Birth:

Person completing form:

Relation to student:

The McKinney-Vento Act (42 U.S.C.11434a (2)) defines the rights of students without fixed, regular and adequate housing. Your response to these questions will help staff determine what residency/enrollment documents are necessary for enrollment of your child(ren) and the services your children may be eligible to receive. Presenting a false record or falsifying records is an offense, and enrollment of a child under false documents subjects the person to liability for tuition or other costs.

1. Is the student’s current address a temporary living arrangement? 2. Is this temporary address due to a military/PCS move? 3. Is this temporary living arrangement due to loss of housing, economic hardship, domestic violence, or divorce? 4. Is the student an unaccompanied youth (not in the physical custody of a parent or legal guardian)? 5. Is the student in Foster Care?

Yes

No

Yes

No

Yes

No

Yes

No

REQUIRED

Yes No If you answered YES to ANY question, please complete the remainder of this form. If you answered NO to ALL question, please sign the bottom of the form and continue with enrollment. --------------------------------------------------------------------------------------------------------------------------------------------------Please check the setting that best describes where the student is presently living. (CHECK ONE) In an Emergency or Transitional Shelter, Name: ______________________________________ In a hotel or motel, camper, campsite or car due to lack of alternative, adequate accommodations Name and address: __________________________________________________________________ With more than one family in a house or apartment # Bedrooms ________ #People _________ Host Name:______________________________________________ Relation to student:____________________ Host Address: ____________________________________________ Host Phone:_____________________ Host Signature:_______________________________________________________ In a park, public space, abandoned building, bus or train station, or similar settings School/Grade

Male

Present Address

Phone

Sibling Names

Female

School (and Not In School)

Note to Staff: Please check if received: Birth Certificate Shot Records Send all completed and signed LPS Student Residency Questionnaires to the LPS FEDERAL PROGRAMS office. For immediate assistance call the LPS McKinney-Vento Homeless and Foster Care Liaison at 580 215 0255, ext. 2311 Signature: ________________________________________________________ Date: ___________________________

Cuestionario Sobre Residencia del Estudiante ESCRIBA EN LETRA DE IMPRENTA

Nombre del estudiante: Persona completando la forma:

Fecha de Nacimineto: Relación con estudiante:

La Ley McKinney-Vento (42 U.S.C.11434a(2)) define los derechos de estudiantes que no tienen una residencia fija, regular, y adecuada. Su contesta a estas preguntas ayudará al personal escolar de determinar los documentos necesarios para registración en la escuela y también a determinar los servicios que el estudiante puede ser elegible para recibir. Presentar un expediente falso o falsificar expedientes es delito, e inscribir a su hijo con documentos falsos le hace responsables por el pago de colegiaturas y otros costos.

1. ¿Es el domicilio actual del/de la estudiante sólo temporal? 2. ¿Es este domicilio temporal resultado de un traslado militar (PCS)? 3. ¿Es su domicilio temporal debido a la pérdida de vivienda, a problemas económicos, a violencia familiar o divorcio? 4. ¿Es el/la estudiante un/a joven sin compañía adulta (sin la custodia física de un padre o tutor legal? 5. ¿Está el estudiante en un hogar de niños?

Sí

No

Sí

No

Sí

No

Sí

No

Obligatorio

Sí No Si respondió Sí a CUALQUIERA de las preguntas, por favor, responda el resto de este formulario. Si respondió NO a todas las preguntas, firme el die del formulario y continúe con la inscripción. --------------------------------------------------------------------------------------------------------------------------------------------------Favor de marcar solo el espacio (uno) que mejor describa el lugar donde el estudiante vive actualmente. En un albergue de emergencia o de transición, nombre: ______________________________________ En un hotel o motel, remolque residencial, o parque de acampar debido a la falta de una residencia adecuada alternativa, nombre: __________________________________________________________________ Con más de una familia en una casa o apartamento Nro de habitaciones ________ Nro de personas_________ Nombre del dueño:______________________________________ Relación con estudiante:____________________ Dirección del dueño: ____________________________________________Teléfono:_____________________ Firma del dueño:_______________________________________________________ En un parque, espacios públicos, edificios abandonados, estaciones de autobús o de tren, u otros lugares similares Escuela/Grado

Masculino

Dirección actual

Teléfono

Nombres de hermanos/as

Femenino

Escuela (o no en escuela)

Note to Staff: Please check if received: Birth Certificate

Shot Records Send all completed and signed LPS Student Residency Questionnaires to the LPS FEDERAL PROGRAMS office. For immediate assistance call the LPS McKinney-Vento Homeless and Foster Care Liaison at 580 215 0255, ext. 2311

Firma: ________________________________________________________ Fecha: ___________________________