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Student Residency Form
Your child may be eligible for additional educational services through the McKinney-Vento Assistance Act. To determine your child's eligibility, please complete this form.
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* Indicates required question
Student
LAST NAME
*
Your answer
Student
FIRST NAME
*
Your answer
Name of School
*
Choose
North Star Montessori Academy
Student Address
*
Your answer
Phone Number
*
Your answer
Student birthdate: month/day/year
*
Your answer
Sex
*
Male
Female
Name of adult completing this form. Typing your name certifies that the information provided is accurate.
*
Your answer
Please check your relationship to the student
*
Parent
Legal Guardian
Power of Attorney
Adult caring for student
Youth living without being in the custody of a parent or legal guardian
Required
Date completing this form:
*
MM
/
DD
/
YYYY
Is the student's current address a temporary arrangement?
*
YES
NO
Is this temporary living arrangement due to loss of housing or economic hardship?
*
YES
No
If you answered YES to the above questions, please complete the final question on this form.
Where is the student living? Check ONE box
Temporarily with another family in a house or apartment due to loss of housing or economic hardship
With an adult that is not a parent or legal guardian, or alone without an adult
Moving from place to place
In a hotel/motel
Staying in a shelter (family shelter, domestic violence shelter, youth shelter)
Waiting for foster care placement or in a new foster care placement (less than 6 months)
In a car, park, campground, abandoned building, OR any other inadequate accommodation
In an emergency/transitional shelter
Unknown nighttime residence
Other:
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