Homeless Student (McKinney-Vento) Eligibility and Services Form

Documents a student's McKinney-Vento eligibility status and the enrollment, transportation, and support services needed to maintain school access and stability.

Submission Notice and Privacy Disclosure

• I understand this form is used to review McKinney-Vento eligibility and document school supports.
• Consent to collect and use the information provided for eligibility review and service coordination
  By submitting, you consent to the collection and use of the minimum necessary PII for school enrollment, transportation, and support coordination.
• Request anonymous submission for initial concern reporting
  Select only if you want to submit a concern without identifying the student initially. A follow-up may be needed to complete eligibility review.
• Submitter role

Student and Case Identification

• Student full name
• Student date of birth
  Provide only if needed to match the student record.
• Student ID
  Optional if the student already has a district ID.
• Current or requested school
• Grade level
• Case open date

McKinney-Vento Eligibility Review

• Current housing situation
• Is the student an unaccompanied youth?
• Eligibility basis
• Eligibility determination
• Determination notes
  Record only objective facts needed for the audit trail and case review. Avoid unnecessary personal details.

Enrollment and School Stability Supports

• Immediate enrollment support needed
• Records or documents needed for enrollment
• School of origin requested
• School stability supports needed

Transportation and Service Plan

• Transportation to school of origin needed
• Transportation mode
• Transportation start date
• Additional services requested

Review, Sign-Off, and Audit Trail

• McKinney-Vento liaison name
• Review date
• Decision summary
  Summarize the eligibility decision and the supports approved.
• Parent/guardian or youth signature
  Use when signature is available and appropriate.
• Staff signature