STUDENT QUESTIONNAIRE | Academia Del Pueblo

Gender

Male

Female

Presently, where does the student stay at night?1. Is your current address a temporary living arrangement? Please check one:

Yes

No

Presently, where does the student stay at night? 2. Is this temporary living arrangement due to loss of housing or economic hardship? Please check one:

Yes

No

Where is the student presently living?

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 (es. car, park and campsite)

I certify that the above- named student qualifies for the Child Nutrition Program under the provisions of the McKinney – Vento Act

Yes

No

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Si respondió SÍ a las preguntas anteriores, complete el resto de este formulario. Si respondió NO, firme y feche al final.

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