McKinney-Vento Act/AAECS Eligibility Form

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In 1987, Congress passed the Stewart B. McKinney Homeless Assistance Act, (subsequently renamed the McKinney-Vento Homeless Assistance Act) to aid homeless persons. The Act defines the term "homeless children and youths" as individuals who lack a fixed, regular, and adequate nighttime residence.

Mrs. Geyer is the McKinney-Vento Liaison for AAECS. Mrs. Geyer works with families to coordinate services to ensure that homeless children and youth remain enrolled in school and have the opportunity to succeed academically.

If you are experiencing homelessness or displacement or would like to see if you qualify, please complete this form. This confidential information will be used to determine eligibility and the services that the student may be able to receive.

You can also reach Mrs. Geyer at 610-841-4560 or ngeyer@artsacademyecs.org.

Email *

Student's Name *

Student's Current Address/Residence *

Parent/Guardian's Name *

Parent/Guardian's Phone Number *

Parent/Guardian's Relationship to the Student *

Biological Mother

Biological Father

Legal/Court Appointed Guardian (Court Documents Required)

Other:

Is the student in the physical custody of the parent/legal guardian? *

Yes

Is the parent/guardian a veteran or currently enrolled in the military? *

Veteran

Active Military member

Not a veteran or active military member

Student's Current Nighttime Status (Where the child sleeps) *

Unsheltered (campground, car, abandoned building, park, temporary trailer, street)

Shelter (Emergency, transitional, or domestic violence shelter)

Hotel/Motel (due to lack of other suitable housing)

Doubled Up (temporarily with family or other person due to loss of housing situation)

Permanent Housing (student lives in a fixed, regular and adequate housing situation)

Unaccompanied Youth (if the student is NOT in the physical custody of a legal parent or guardian)

Student is Awaiting Foster Care Placement

Required

Please provide a brief description and/or name of any temporary housing listed above (name of motel, shelter, etc). *

Please list names, ages, grade level and schools for all other children living in the same arrangement.

Please provide the event that resulted in loss of housing for the student *

Abandonment

Act of Nature

Death of Parent/Guardian

Domestic Violence

Eviction

Fire

Left Home

Parent/Guardian Hospitalized

Parent/Guardian Incarcerated

Parental Job Loss/Loss of Income

Military

Other:

Required

Date of Loss of Home/Displacement *

YYYY

Are you currently working with an agency for resources? *

Yes

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