Please use this form to submit a student as a referral for consideration as qualified for McKinney Vento. This referral will trigger an application for Free/Reduced Lunch and a referral to the Homeless Coordinator. If you have additional concerns about a student, please contact the guidance or administrators.

* Required

Email address *

Students Last Name *

Students First Name *

Building

Richards

NMHS/SRVRTC

Current Living Situation *

To qualify for McKinney Vento status, a student must live in one of the following situations.

Sharing the housing of other persons due to loss of housing or economic hardship.

Living in motels, hotels, trailer parks, or camping grounds due to lack of alternative adequate accommodations

Living in emergency or transitional shelters.

Living in cars, parks, public spaces, abandoned buildings, substandard housing or bus or train stations.

Children and youth who have a primary nighttime residence that is a public or private place not designed for, or ordinarily used as, regular sleeping accommodations

Migratory children who qualify as homeless because they are living in the circumstances described above

Unaccompanied youth (Any youth up to age 21 who is homeless and not in the PHYSICAL custody of his/her parent/guardian)

Lacks fixed, adequate, or regular nighttime residence

Other:

School Year 18-19

Grade *

Student's Advisory/Teacher

Does the student have siblings who attend a Newport School District School?

Yes

If siblings, please list below

Parents Name

Unaccompanied youth do not need to provide this information

Parent/Guardian Address

Parent Phone

Parent/Guardian - Email

Person filling out form *

Notes

A copy of your responses will be emailed to the address you provided.

Security Measure

School AdministrativeUnit 43

86 N. Main Street, Newport, NH 03773
Phone: 603-865-9500Fax: 603-865-9555

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