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Get MI Beaverton Rural Schools McKinney Vento Homeless Act – Intake (Student Identification Form)

Er: Yes Siblings in same district? Female Sibling in preschool? Yes No No Unsure Unsure Sibling names(s): Emergency Shelter 10 Transitional Housing 11 Homeless Status Foster Care Doubled Up 12 13 Living Situation (check one) (Current foster home for less than 6 months) Agency: Motel 14 Unsheltered 15 (Sharing a house with others due to loss of housing or economic hardship, couch surfing ) (Temporary situation due to fire, eviction, foreclosure) (Living in a car, park, camp.

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