Family Facing McKinney-Vento Survey

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This survey is to determine eligibility for educational support and other resources through the Federal McKinney-Vento Homeless Assistance Act. Information collected through this form is confidential. Please answer the following questions to the best of your ability. Thank you for helping us better serve our DPAC community!

Email *

Please provide your full name. *

Please provide the name and grade of your scholar/scholars. *

Please describe your family's current housing situation. Check all that apply. *

Own/rent house, apartment or condominium

Living in a shelter (emergency, transitional or family program)

Living in a motel, hotel or weekly rate housing

Living in a house or apartment owned/rented by friends or relatives due to economic hardship or loss

Living in an abandoned building, a car, at a campground site or on the street

Living somewhere without electricity, heat or water

Required

If eligible, would you like to be contacted with more information regarding McKinney-Vento services? *

Yes

Required

If you answered Yes to the previous question, please provide your phone number below:

Submit

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