McKinney-Vento Homeless Assistance Act Survey

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To obtain an accurate depiction of our families' living arrangement, we are requesting that each of our families complete this survey. This information will kept confidential and used only for informational purposes only. Subtitle VII-B of The McKinney-Vento Act provides rights and services to children and youth experiencing homelessness at a federal, state, and local level. Further, it ensures that homeless children and youth are identified and enrolled in school, and have a full and equal opportunity to succeed in school.

Your Name *

Please list all of YOUR preschool and school-aged children currently living with you:

Are you or your family experiencing homelessness? *

Yes

Please select the statement that most applicable to your living arrangement. *

Sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason

In a motel, hotel, campground, or similar setting due to a lack of alternative adequate accommodations

In an emergency or transitional shelter.

Have a primary nighttime residence that is not designed for or ordinarily used as a regular sleeping accommodation for humans.

In a car, park, public space, abandoned building, substandard housing, bus or train station, or a similar setting.

None of the above

Required

Current Address *Please include city and zip code* *

How long do you anticipate living at this location? *

1 - 2 months

3 - 4 months

5 - 6 months

More than 6 months

Not applicable

What's the best way to reach you? ****List Contact Information**** *

Submit

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