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Academy Del Pueblo Student Questionnaire

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

If you answered YES to the above questions, please complete the remainder of this form. If you answered NO, please sign and date the bottom.

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

This questionnaire is intended to address the McKkinney – Vento Act 42 U.S.C 11435. The answers to this questionnaire information help determine the services the student may be eligible to receive. 

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