Page 45 - Community Resource Guide

Could you be asked to leave at any time?
Where would you go if you couldn’t stay where you are?
Where were you living before?
Regular
Do you stay in the same place every night?
How long have you been staying in your current situation? How long do you plan to stay?
How long did you live in your last place?
Adequate
Is there adequate heat, electricity and water? What are the conditions of the living situation?:
Clean Safe In Adequate Repair Crowded
How many people are in the living situation? How many bedrooms are there?
Where are you sleeping?
Yes No
Yes No
Yes No
Yes No
Yes No Yes No Yes No
Please use page 3 to explain reasons for Homelessness
2. UnaccompaniedYouth:Notinthephysicalcustodyofaparentorguardian. Check one box.
qStudent(s) is living with an adult that is not their parent or legal guardian (due to family homelessness, runaway and not for purposes of school preference.)
qStudent is living alone without a parent or legal guardian (due to family homelessness, runaway and not for purposes of school preference.)
Please explain any extenuating circumstances on page 3.
qStudent does not meet the definition of “Unaccompanied Youth.” Initial ________
If 1 or 2 do not apply to you, please see school personnel for other enrollment options.
3.
Pleaselistthenamesofallimmediatefamily members attending K-12 school in Hampton City Schools.
DO NOT INCLUDE THE CHILDREN OF THE HOST FAMILY.
Middle Last
First
DOB
Grade
School Name
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Last Revised June 19, 2019