McKinney Vento Family Intake Form for Sugar Creek Charter School

McKinney Vento Family Intake Form for Sugar Creek Charter School

Please provide your family's information to complete the intake process.
Parent/Guardian Full Name

First NameLast Name
Student Full Name

First NameLast Name
Student Grade Level
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email Address
example@example.com
Current Housing Situation

Other
Current Address (if available)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
List all siblings attending Sugar Creek Charter School (names and grade levels)
If you have siblings not attending Sugar Creek Charter School, please fill below (name, age, grade, DOB)
Referrer's Name

First NameLast Name
Referrer's Relationship to Student
Referrer's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Referrer's Email
example@example.com
Date

MonthDayYear
Date
My signature below affirms the following (1) the information I have provided is true and accurate to the best of my knowledge or belief, (2) this information, as well as other information that may identify my child(ren), may be shared wit or without my consent with community and governmental agencies pursuant to the inter-agency collaboration between Sugar Creek Charter School and social service agencies; and (3) this information may be shared with or without my consent with other staff members for a legitimate educational purpose. In addition, my signature affirms that / have received a copy of my rights under the McKinney-Vento law and / agree to allow Sugar Creek Charter School staff to conduct screenings as a part of the McKinnery-Vento program.
Should be Empty: