McKinney Vento Referral Form

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McKinney Vento Act defines "homeless children and youths" as "individuals who lack a fixed, regular, and adequate nighttime residence."

All the information is confidential. The purpose of identification is to provide support and offer appropriate services to the family, child and/or youth.

Email *

Student's Name/School Name (include all students in the home, if not enrolled please note "not enrolled" *

Parent's name/Guardian, phone number and best way to contact: *

Name of the person completing the form: Name, title or organization, phone number/email. *

Please describe reasons your are reaching out. List any immediate needs and support. *

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