NM Student Residency Questionnaire Form 2021-2022

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This form is to consider whether your child(ren) may be eligible for additional educational services through Title I part A, Title I Part C-Migrant, and/or Title X, Part C, Federal McKinney-Vento Assistance ACT. Eligibility can be determined by completing this questionnaire. Please fill out and submit, thank you.

NOTE: IF YOU HAVE MORE THAN ONE CHILD PER HOUSEHOLD, LIST THEM ALL ON THIS ONE FORM.

Presently, where are you and your family currently staying?

Section A- if you check the box "rent/own my own home", then please sign at the bottom of the form and submit (no other portion of the form needs to be worked on).

Rent/Own my own home

Section B- If you checked a box in section B, please complete the remainder of this form.

Temporarily with another family because we cannot afford or find affordable housing.

With an adult that is not a parent of legal guardian, or alone without an adult.

In a motel, hotel, trailer park, or campground without running water/electricity.

In a vehicle of any kind, abandoned building or substandard housing.

In an emergency/transitional shelter.

Other:

Have you moved in the past 3 years to seek work as a paid laborer in any type of farming (sod, dairy, chicken, vegetable, citrus, or other) or fishing?

Yes

Clear selection

If you checked a box in section B, your child(ren) may be eligible for additonal educational services through Title I part A, Title I Part C-Migrant, or Title X, Part C, Federal McKinney-Vento Assistance ACT

Please list your child(ren) name(s) (first, middle, last)

Gender

If more than one child, Please put child's first name, then gender, for each child.

Date Of Birth

If more than one child, Please put child's first name, then DOB, for each child.

Grade Level

If more than one child, Please put child's first name, then grade, for each child.

School Name

If more than one child, Please put child's first name, then school name, for each child.

Would you like to be contacted by a member of the schools system's Education for Homeless Children and Youth program staff?

Yes

Clear selection

By signing this form, I certify that the information provide above is accurate. *

Parent/Guardian Please sign below

Submit

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