Housing Questionnaire

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Blair Oaks High School is required to collect housing information on every student in order to be in compliance with federal programs.

These questions cover the definition of homeless that is within the Every Student Succeeds Act (ESSA) and will meet MSIP 5 Resource and Process Standards for G-5.

Reference:
Blair Oaks R-II School District Homeless Enrollment Form, https://tinyurl.com/y66vwg2j

Email *

Student's Last Name *

Student's First Name *

Student's Grade *

Question 1 *

Are you sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason?

Explain if it is a similar reason. (If applicable in Question 1)

Question 2 *

Are you currently residing at a motel, hotel, in a car, or at a campsite because your home has been damaged or because of economic reasons?

Question 3 *

Are you currently residing in a shelter?

Question 4 *

Are you currently living in a temporary housing arrangement due to economic hardship?

If additional comments/details needed, please submit here.

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