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Date: May 27 , 2023

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COPYRIGHT @ 2022 HUNTSVILLE CITY SCHOOLS

IN ACCORDANCE WITH THE REQUIREMENTS OF TITLE II OF THE AMERICANS WITH DISABILITIES ACT OF 1990 ("ADA"), THE HUNTSVILLE CITY BOARD OF EDUCATION WILL NOT DISCRIMINATE AGAINST QUALIFIED INDIVIDUALS WITH DISABILITIES ON THE BASIS OF DISABILITY IN ITS SERVICES, PROGRAMS, OR ACTIVITIES. FOR MORE INFORMATION PLEASE CONTACT THE COMPLIANCE DEPARTMENT.

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Parent/Guardian or Unaccompanied Youth Information

Please enter the name of the parent/guardian completing this form out.
Please enter a valid phone number for the person submitting this form.
Please provide the name of the shelter, hotel address, or location of where you slept last night.
Preferred Communication
Please choose the preferred methods of communication. (Check all that apply.)

Student Information

Please select the school of the student in need of assistance.
Student IEP?
Please indicate whether the student has an IEP.
Student Transportation
Does the student have reliable transportation?
Second Student
Please indicate whether you have another student living in the household.

Student 2 Information

Please select the school of the student in need of assistance.
Student 2 IEP?
Please indicate whether the student has an IEP.
Third Student
Please indicate whether you have another student living in the household.

Student 3 Information

Please select the school of the student in need of assistance.
Student 3 IEP?
Please indicate whether the student has an IEP.
Fourth Student
Please indicate whether you have another student living in the household.

Student 4 Information

Please select the school of the student in need of assistance.
Student 4 IEP?
Please indicate whether the student has an IEP.

Family Situation

Family Needs
Is your family in need of any of the above? (Please check all that apply.)
Current Living Situation
Where is the student or students living right now? (Select only one.)
Reason(s)
Please indicate the primary reasons for homelessness. (Please check all that apply.)
Please explain the circumstances that lead to your homelessness.

Declarations

Please enter the last date of permanent residency.
Guardian or Student Declaration
Please select yes or no to affirm the above statement.
Declaration of Understanding
Please select yes or no to affirm the above statement.
TYPE OF ORGANIZATION
MINORITY OWNED BUSINESS

Names of Officers, Members or Owners of Concern, Partnership, Etc.

Names of Officers, Members or Owners of Concern, Partnership, Etc.

Person of Concern 1

Persons to Contact on Matters Concerning Bids and Contracts

Person to Contact 1

Person to Contact 2

COMMODITY LIST

Check all that apply.
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