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Student Housing Questionnaire
Determination of Services under the McKinney-Vento Act
Student Name
*
First
Last
Grade
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Eigth
Freshman
Sophmore
Junior
Senior
Contact Phone
Present Housing Situation
Check all that apply:
Residing in owned or rented housing
Our current address is a temporary living arrangement
Living with friends or extended family members due to lack of housing or hardship
Living in a motel, a camper, bus, car, park or campsite
Moving from place to place
Living with a family member: grandparents, aunts or uncles, other relative
Inadequate housing (lacks kitchen, bathroom facilities, no heat or electricity, in need of extensive repairs, not enough space)
Unaccompanied youth (not in the physical custody of parent or guardian) who are in crises or unstable housing
Awaiting foster care placement
In a shelter, ie. La Puente, Tu Casa
Check all that apply:
Student stays with friends or away from home over 50% of the time
Student is a school-aged mother or pregnant and staying with friends
Student is a runaway or youth without adult supervision
Student is staying in “safe houses” because returning to their permanent home would mean returning to a situation involving domestic violence
What service/assistance could you benefit from if the student qualifies?
Check all that apply:
School Supplies
Clothing
Glasses
Emergency medical/dental
Food
Please contact Kate Michaels, RN at (719)658-2220 ext. 115 with additional questions or concerns.
Home
About Us
Administration
Faculty
Contact
Employment
Hours of Operation
Activities
Academic & Athletic Programs
Clubs and Groups
Community Sponsored Programs
Board
Board News
Directors and Offices
District Policies
Meeting Agendas
Meeting Minutes
Strategic Plan Goals
Calendars
Calendar of Events
District Calendar
Testing Calendar
Family
2020 Census
Absence
Creede Early Learning Center
Drop Off/Pick Up Procedures
Free & Reduced Lunch Application
Gifted and Talented
Go Edustar
Grievance Form
Health Office
Hot Lunch
Late Start and Closing Procedures
Newsletters
Parent Teacher Organization
Restorative Practices
Safety
School Supplies
Student Handbook
Title IX
Student
CMAS Assessments
College Guidance
Dance Guest Pass Form
Go Edustar
Parking Permit
Senior Student Early Dismissal Application
Student Handbook
Transcript Request
Teacher
Accident Report
Faculty Handbook
Facility Use Request Form
Maintenance Request
Purchase Requisition
Staff Evaluation Procedures
Teacher Resources
Transportation/Field Trip Request
Registration
Annual Agreement Forms
Enrollment Form
Health Information Card
OTC Medication Form
Student Housing Questionnaire
Transportation Contract – Mineral County Residents Only
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