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Self-Identification Form for Homeless and Highly Mobile Students
Title 1 - McKinney Vento
Please answer the questions below to best describe your living situation. The purpose of this information is to ensure the rights of you and your children under the McKinney Vento Act. The information you provide is confidential.
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Do you or your family currently live in any of these situations? (Check all that apply)
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I stay in either a shelter or a transitional housing/independent living program.
I am doubled-up with friends or relatives, but I am not on their lease.
I stay on the streets (in an abandoned building, in a car, or in other unsafe conditions)
I stay in a hotel/motel.
I am in a temporary foster care placement.
I am under 18 and do not live with a parent or guardian.
One of the above situations applies to me, and I have a child.
Required
If you did not check any box above, you do not need to complete or submit this form.
If you checked any of the above situations, you are entitled to the following rights:
To attend school, to continue in the school you and your child attended before you became homeless (school of origin), and if feasible, to receive transportation to that school.
To enroll in school without a permanent address and attend classes while the school arranges for a school transfer, immunization records, or other documents required for enrollment.
To receive the same special programs and services, if needed, as provided to all other children served in these programs.
To have enrollments disputes addressed quickly.
Please list all children currently living with you, including their Full Name (First Middle Last), gender, date of birth, and grade level.
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Your answer
Please sign your name to confirm the information above is correct.
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Your answer
The McKinney Vento Homeless Education Assistance Act and PACT Charter School assures the educational rights listed above for all homeless and highly mobile students. Call the District Homeless Liaison for further information:
763-712-4200 x2234.
Your information is confidential and shall be kept for the current school year only. For a copy of this document, please email Paul Bjork: p.bjork@pactcharter.org
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