McKinney-Vento Residency Form

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2020-2021 School Year

The questions below are to assist in determining if students meet the eligibility criteria for services provided under the McKinney-Vento Act.

The McKinney-Vento Homeless Education Assistance Act is a federal law that ensures immediate enrollment and educational stability for displaced children and youth. The information you provide will be kept confidential.

If you have any questions or concerns, please call the Manchester School District Homeless Education Liaison, Jocelyne Pinsonneault at 665-6868.

Are you temporarily staying in one of the following places due to loss of housing or economic hardship?

****PLEASE DO NOT CONTINUE FILLING OUT THIS FORM IF ABOVE DOES NOT APPLY TO YOU****

It is the policy of the Manchester Board of School Committee, in its actions, and those of its employees, that there shall be nondiscrimination on the basis of age, sex, race, color, marital status, physical or mental disability, religious creed, national origin or sexual orientation for employment in, or operation and administration of any program or activity in the Manchester SchoolDistrict.

Sljedeća su pitanja koja će vam pomoći u utvrđivanju ispunjavaju li studenti kriteriji podobnosti za usluge koje se pružaju McKinney-Vento Zakonom.

McKinney-Vento Zakon o pomoći beskućnicima u obrazovanju je savezni zakon koji osigurava neposredan upis i stabilnost obrazovanja za raseljenu djecu i mlade. Podaci koje navedete čuvat će se u tajnosti.

Ako imate bilo kakvih pitanja ili nedoumica, nazovite vezu za školovanje beskućnika u školskom okrugu Manchester, Jocelyne Pinsonneault na 665-6868.

Privremeno boraviš na nekom od sljedećih mjesta zbog gubitka stambenog prostora ili ekonomske poteškoće?

**** MOLIMO VAS DA NE NASTAVLJAJU OVAJ OBRAZAC AKO SE NAKON VAS NE PRIJAVI ****

Politika Mančesterskog odbora za školstvo, u svojim postupcima, i njegovih zaposlenih, neće biti diskriminacije na osnovu starosti, pola, rase, boje, bračnog statusa, fizičke ili mentalne invalidnosti, verske veroispovesti, nacionalnog porijekla ili seksualne orijentacije za zapošljavanje u ili rad i upravljanje bilo kojim programom ili aktivnostima u Manchesterovoj školskoj četvrti.

Email *

Are you temporarily staying in one of the following places due to loss of housing or economic hardship? Privremeno boraviš na nekom od sljedećih mjesta zbog gubitka stambenog prostora ili ekonomske poteškoće? *

In a motel/hotel U motelu / hotelu

In a shelter (Families in Transition, Emergency Shelter, Rooming House) U skloništu (Porodice u prijelazu, Prihvatilište za hitne slučajeve, Soba za spavanje)

With more than one family (sharing a house or an apartment Sa više porodica (dijeli kuću ili stan

Moving from place to place Krećući se od mjesta do mjesta

In a place not design for ordinary sleeping accommodations, such as a car, park, campsite Na mjestu koje nije dizajnirano za uobičajene spavaće prostore, poput automobila, parka, kampa

Required

Name of your student(s) in Manchester School District if ONLY the above applies to you. You only need to fill our ONE form per family). [FIRST AND LAST NAME, GRADE, SCHOOL] Ime vašeg učenika u školskom okrugu Manchester ako se SAMO gore navedeno odnosi na vas. Potrebno je samo da ispunite naš JEDAN obrazac po porodici). [PRVI I POSLEDNI IME, GRAD, ŠKOLA] *

Do you have a preschooler at home? Imate li predškolca kod kuće? *

Yes da

No ne

Are you the Jesi li ti taj *

Student's Parent Student's Roditelj

Student's Guardian

or an Unaccompanied Youth* ili mladi bez pratnje *

Address where student(s) is/are staying [House # Street, APT# CITY, STATE, ZIP] Adresa na kojoj borave / borave studenti [Kuća # ulica, APT # GRAD, DRŽAVA, ZIP] *

Best Phone Number [indicate cell or home] Najbolji telefonski broj [naznačite mobitel ili dom] *

Under penalty of perjury under the laws of this state, I declare that the information provided here is true and correct and of my own personal knowledge, and if called upon to testify, I would be capable to do so. Pod kaznom lažnog kršenja prema zakonima ove države izjavljujem da su ovdje navedeni podaci istiniti i tačni te da sam lično upoznat i ako bih bio pozvan da svjedočim mogao bih to učiniti. *

yes, I understand da, razumijem

no, I don't understand ne, ne razumem

Name of person completing this form [FIRST NAME LAST NAME] This serves as your signature of acknowledgement Ime osobe koja ispunjava ovaj obrazac [PRVI IME ZADNJI IME] Ovo služi kao vaš potpisni znak *

Send me a copy of my responses.

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