Beruflich Dokumente
Kultur Dokumente
This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11434a(2). The answers to this residency information help determine the services the student may be eligible to receive. 1. 2. 3. Is your current address a temporary living arrangement? _____ Yes _____ No _____ No
Is this temporary living arrangement due to loss of housing or economic hardship? _____ Yes Are you an unaccompanied minor child? _____ Yes _____ No
If you answered YES to the above questions, please complete the remainder of this form. If you answered NO, you may stop here. Where is the student presently living? (Check one box.)
In a motel In a shelter With more than one family in a house or apartment Moving from place to place In a place not designed for ordinary sleeping accommodations such as a car, park, or campsite
Name of Parent(s)/Legal Guardians(s) __________________________________________________________ Address________________________________________________ Zip __________ Phone_______________ Parent or student email address ____________________________________________ Presenting a false record or falsifying records is an offense under Section 37.10, Penal code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d).
Please provide the following information for school-age siblings (brothers and/or sisters) of the student: Name Grade Level School Student ID#
I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act. __________________________ Date _____________________________________________________ McKinney-Vento Liaison Signature
_____S _____ S
_____ No _____ No
En un motel En un albergue o lugar de refugio Con ms de una familia en una casa o apartamento Mudndose de lugar en lugar En un lugar no designado para dormir (ejemplo: carro, parque, o campamento)
Nombre de Padre/Madre/ Tutor_____________________________________________________________ Direccin ______________________________________ Zona Postal _________ Telfono ______________ E-mail de padre o estudiante ___________________________________ La falsificacin de informacin o documentos son ofensas bajo la Seccin 37.10 del Cdigo Penal, y la inscripcin del estudiante usando documentos falsos conlleva la responsabilidad del pago de gastos de instruccin y miscelneos por parte de la persona responsable. TEC Sec. 25.002(3)(d).
Srvase proporcionar la siguiente informacin sobre todo menor de edad escolar que sea hermano/a del/a estudiante:
Nombre Nivel de grado Escuela # de identificacin escolar
Firma del Padre/Madre/Tutor_________________________________________ Fecha _______________________ Por la presente declaro que el estudiante nombrado en este formulario llena los requisitos para recibir servicios de comedor bajo las provisiones del Acta McKinney-Vento. ___________________________ Fecha ______________________________________________________ Firma de oficial autorizado