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Parent/Guardian or Unaccompanied Youth Information
Name
Please enter the name of the parent/guardian completing this form out.
Email Address
Please enter the email address of the parent/guardian completing this form.
Phone Number
Please enter a valid phone number for the person submitting this form.
Current Location
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.)
Email
Phone (Voice)
Phone (Text Message)
Student Information
Student Name
Student Date of Birth
School Name
Please select the school of the student in need of assistance.
- Select -
Academy for Academics and Arts Elementary
Academy for Academics and Arts Middle
Academy for Science & Foreign Language Elementary
Academy for Science & Foreign Language Middle
Blossomwood Elementary
Chaffee Elementary
Challenger Elementary
Challenger Middle School
Chapman Middle School
Columbia High School
Farley Elementary School
Goldsmith-Schiffman Elementary
Grissom High School
Hampton Cove Elementary School
Hampton Cove Middle School
Highlands Elementary School
Huntsville Junior High School
Jemison High School
Jones Valley ElementarySchool
Lakewood Elementary
Lee High School
Martin Luther King Jr. Elementary
McDonnell Elementary
Monte Sano Elementary
Montview Elementary
Morris Middle School
Mountain Gap Elementary
Mountain Gap Middle School
New Century Technology High School
Providence Elementary School
Ridgecrest Elementary
Rolling Hills Elementary School
Ronald E. McNair Jr. High
Sonnie Hereford Elementary
Weatherly Heights Elementary
Whitesburg Elementary
Whitesburg Middle School
Williams Elementary
Williams Middle
Student Gender
Student Age
Student Grade
- Select -
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student Ethnicity
- Select -
Asian
Black/African American
Multi Race - 2 or More Races
American Indian/Alaskan Native
White
Native Hawaiian or Pacific Islander
Hispanic
Student IEP?
Please indicate whether the student has an IEP.
Yes
No
Student Transportation
Does the student have reliable transportation?
Yes
No
Second Student
Please indicate whether you have another student living in the household.
Yes
No
Student 2 Information
Student 2 Name
Student 2 Date of Birth
School Name 2
Please select the school of the student in need of assistance.
- Select -
Academy for Academics and Arts Elementary
Academy for Academics and Arts Middle
Academy for Science & Foreign Language Elementary
Academy for Science & Foreign Language Middle
Blossomwood Elementary
Chaffee Elementary
Challenger Elementary
Challenger Middle School
Chapman Middle School
Columbia High School
Farley Elementary School
Goldsmith-Schiffman Elementary
Grissom High School
Hampton Cove Elementary School
Hampton Cove Middle School
Highlands Elementary School
Huntsville Junior High School
Jemison High School
Jones Valley ElementarySchool
Lakewood Elementary
Lee High School
Martin Luther King Jr. Elementary
McDonnell Elementary
Monte Sano Elementary
Montview Elementary
Morris Middle School
Mountain Gap Elementary
Mountain Gap Middle School
New Century Technology High School
Providence Elementary School
Ridgecrest Elementary
Rolling Hills Elementary School
Ronald E. McNair Jr. High
Sonnie Hereford Elementary
Weatherly Heights Elementary
Whitesburg Elementary
Whitesburg Middle School
Williams Elementary
Williams Middle
Student 2 Gender
Student 2 Age
Student 2 Grade
- Select -
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student 2 Ethnicity
- Select -
Asian
Black/African American
Multi Race - 2 or More Races
American Indian/Alaskan Native
White
Native Hawaiian or Pacific Islander
Hispanic
Student 2 IEP?
Please indicate whether the student has an IEP.
Yes
No
Third Student
Please indicate whether you have another student living in the household.
Yes
No
Student 3 Information
Student 3 Name
Student 3 Date of Birth
School Name 3
Please select the school of the student in need of assistance.
- Select -
Academy for Academics and Arts Elementary
Academy for Academics and Arts Middle
Academy for Science & Foreign Language Elementary
Academy for Science & Foreign Language Middle
Blossomwood Elementary
Chaffee Elementary
Challenger Elementary
Challenger Middle School
Chapman Middle School
Columbia High School
Farley Elementary School
Goldsmith-Schiffman Elementary
Grissom High School
Hampton Cove Elementary School
Hampton Cove Middle School
Highlands Elementary School
Huntsville Junior High School
Jemison High School
Jones Valley ElementarySchool
Lakewood Elementary
Lee High School
Martin Luther King Jr. Elementary
McDonnell Elementary
Monte Sano Elementary
Montview Elementary
Morris Middle School
Mountain Gap Elementary
Mountain Gap Middle School
New Century Technology High School
Providence Elementary School
Ridgecrest Elementary
Rolling Hills Elementary School
Ronald E. McNair Jr. High
Sonnie Hereford Elementary
Weatherly Heights Elementary
Whitesburg Elementary
Whitesburg Middle School
Williams Elementary
Williams Middle
Student 3 Gender
Student 3 Age
Student 3 Grade
- Select -
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student 3 Ethnicity
- Select -
Asian
Black/African American
Multi Race - 2 or More Races
American Indian/Alaskan Native
White
Native Hawaiian or Pacific Islander
Hispanic
Student 3 IEP?
Please indicate whether the student has an IEP.
Yes
No
Fourth Student
Please indicate whether you have another student living in the household.
Yes
No
Student 4 Information
Student 4 Name
Student 4 Date of Birth
School Name 4
Please select the school of the student in need of assistance.
- Select -
Academy for Academics and Arts Elementary
Academy for Academics and Arts Middle
Academy for Science & Foreign Language Elementary
Academy for Science & Foreign Language Middle
Blossomwood Elementary
Chaffee Elementary
Challenger Elementary
Challenger Middle School
Chapman Middle School
Columbia High School
Farley Elementary School
Goldsmith-Schiffman Elementary
Grissom High School
Hampton Cove Elementary School
Hampton Cove Middle School
Highlands Elementary School
Huntsville Junior High School
Jemison High School
Jones Valley ElementarySchool
Lakewood Elementary
Lee High School
Martin Luther King Jr. Elementary
McDonnell Elementary
Monte Sano Elementary
Montview Elementary
Morris Middle School
Mountain Gap Elementary
Mountain Gap Middle School
New Century Technology High School
Providence Elementary School
Ridgecrest Elementary
Rolling Hills Elementary School
Ronald E. McNair Jr. High
Sonnie Hereford Elementary
Weatherly Heights Elementary
Whitesburg Elementary
Whitesburg Middle School
Williams Elementary
Williams Middle
Student 4 Gender
Student 4 Age
Student 4 Grade
- Select -
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student 4 Ethnicity
- Select -
Asian
Black/African American
Multi Race - 2 or More Races
American Indian/Alaskan Native
White
Native Hawaiian or Pacific Islander
Hispanic
Student 4 IEP?
Please indicate whether the student has an IEP.
Yes
No
Family Situation
Family Needs
Is your family in need of any of the above? (Please check all that apply.)
School Enrollment Assistance
Free School Meals
School Supplies/Backpack
Transportation Assistance to & From School
School Fees (field trips, senior fees, etc.)
Credit Recovery/Summer School/FAFSA
Health and Hygiene Products
Clothing Assistance
Housing Assistance Referral
Referral to Mental Health & Medical Assistance
Other (Please describe in circumstances text box below)
No Assistance Needed At This Time
Current Living Situation
Where is the student or students living right now? (Select only one.)
In an emergency, community, or transitional shelter
In a motel/hotel or campsite due to economic hardship
Doubled up with friends or family members due to the lack of stable housing situation
None of the choices above apply to my current living situation. (Please explain in the circumstances text box below)
Reason(s)
Please indicate the primary reasons for homelessness. (Please check all that apply.)
Foreclosure
Eviction
Death in Family
Medical/Mental
Family Break Up/Divorce
Loss of Job
Legal
Natural Disaster
Financial Hardship
Abandoned
Runaway
Kicked Out
Incarceration
Other (Please explain in circumstances text box below.)
Circumstances
Please explain the circumstances that lead to your homelessness.
Declarations
Permanent Residency
Please enter the last date of permanent residency.
I understand that by clicking SUBMIT below, and under penalty of perjury under the laws of this state, I declare that the information provided here is true and correct and of my own personal knowledge and that, if called upon to testify, I would be competent to do so.
Guardian or Student Declaration
Please select yes or no to affirm the above statement.
Yes
No
I declare that I am EITHER the parent/legal guardian of the student(s) named above who is/are of school age and is/are seeking enrollment in the Huntsville City School System, OR I am an unaccompanied homeless youth who is of school age and is seeking enrollment in the Huntsville City School System.
Declaration of Understanding
Please select yes or no to affirm the above statement.
Yes
No
NAME OF APPLICANT (COMPANY NAME)
ADDRESS TO WHICH BID FORMS ARE TO BE MAILED
E-MAIL ADDRESS TO WHICH BID FORMS ARE TO BE E-MAILED
HOW LONG AT PRESENT ADDRESS
TYPE OF ORGANIZATION
Corporation
Individual
Partnership
IF INCORPORATED, INDICATE WHICH STATE
NUMBER OF EMPLOYEES
MINORITY OWNED BUSINESS
Yes
No
Names of Officers, Members or Owners of Concern, Partnership, Etc.
PRESIDENT
VICE PRESIDENT
SECRETARY
TREASURER
OWNERS OR PARTNERS
Names of Officers, Members or Owners of Concern, Partnership, Etc.
Person of Concern 1
NAME
OFFICIAL CAPACITY
Persons to Contact on Matters Concerning Bids and Contracts
Person to Contact 1
NAME
OFFICIAL CAPACITY
TELEPHONE NUMBER
E-MAIL ADDRESS
NAME
OFFICIAL CAPACITY
Person to Contact 2
TELEPHONE NUMBER
E-MAIL ADDRESS
COMMODITY LIST
Check all that apply.
005 Abrasives
010 Acoustical Tile, Insulating Materials and Supplies
015 Copier Supplies
020 Agricultural Equipment, Implements and Accessories
022 Agriculrutal Implement Parts
025 Air Compressors and Accessories
031 Air Conditioning, Heating and Ventilating Equipment, Parts and Accessories
045 Appliances and Equipment
050 Art Supplies
055 Automotive Accessories, Buses, Trucks, Etc.
060 Automotive Maintenance Items and Repair, Replacement Parts
065 Automotive Bodies and Accessories
070 Automotive Vehicles and Trailers
075 Automotive Equipment and Supplies
080 Badges and Name Tags, Etc.
090 Bakery Equipment, Commercial
110 Automotive Belts
135 Brick and Tile, Etc.
140 Handles - Broom, Brush and Mop
150 Building Accessories/Supplies
155 Building/Structures Fabricated and Prefabricated
165 Cafeteria and Kitchen Equipment, Commercial
175 Chemical Laboratory Equipment
192 Cleaners, Detergents, and Solvents Prepackaged
195 Clocks, Timers and Accessories
200 Clothing and Accessories
205 Computers
210 Culverts (Concrete & Metal), Pipe, Poles/Accessories
220 Instruments/Equipment (Control, Measure, Record) and Supplies
225 Coolers, Drinking Water
240 Kitchen Accessories (Utensils, Glassware, Etc.)
265 Draperies and Upholstery Material (Including Automobile)
280 Electrical Cable and Wire
285 Electrical Equipment and Supplies
287 Electronic Components/Accessories
320 Fastening and Strapping
330 Fence
345 First Aid and Safety Accessories
350 Flag and Poles
360 Floor Covering (Carpet and Tile and Supplies
365 Floor Maintenance Machines and Accessories
375 Food: Bakery
380 Food: Dairy
385 Food: Frozen
390 Food: Perishable
393 Food: Staple Grocery
405 Fuel, Grease and Oil
410 Furniture: Health Care and Hospital Facility
415 Furniture: Laboratory
420 Furniture: Office
430 Gases and Accessories: Laboratory, Medical, and Welding
440 Glass
445 Hand Tools, Accessories and Supplies
450 Hardware and Related Items
485 Janitorial Supplies
490 Laboratory Equipment and Accessories
500 Laundry Equipment and Parts
515 Lawn Maintenance Equipment
540 Lumber and Related Products
550 Traffic Equipment (Barriers, Markers, Signs, Etc.)
556 Transit Bus
557 Transit Bus Accessories/Parts
560 Material Handling Equipment
578 Miscellaneous Products
595 Nursery Stock, Etc.
600 Office Machines, Equipment and Accessories
615 Office Supplies, General
630 Paint, Varnish, Wallpaper and Related Products
635 Paint Equipment and Accessories
640 Paper and Plastic Products, Disposable
665 Plastics, Resins, Fiberglass: Forming, Laminating and Molding Equipment, Accessories & Supplies
670 Plumbing Equipment, Fixtures and Supplies
725 Radio Communication, Telephone and Equipment, Accessories & Supplies
740 Refrigeration Equipment and Accessories
745 Asphalt Materials
750 Aggregate, Concrete, Gravel, Etc.
760 Earth Handling Equipment
770 Roofing and Supplies
785 School Equipment and Supplies
790 Seed, Sod, Soil and Inoculants
795 Sewing Machines and Accessories
803 Sound Systems and Accessories: Intercom, Public Address
805 Athletic Equipment, Apparel and Awards
820 Boilers, Heat Exchangers, Etc.
840 Television Equipment and Accessories
855 Theatrical Accessories
863 Tires and Tubes
870 Awnings and Blinds
880 Projectors, Accessories and Supplies
885 Water Treatment Chemicals
910 Building Maintenance and Repair Services
929 Equipment Maintenance, Recondition/Repair
931 Equipment Maintenance, Recondition/Repair-Cafeteria, Food Processing, Furniture and Lighting Fixtures
934 Equipment Maintenance, Recondition/Repair
936 Equipment Maintenance, Recondition/Repair
940 Computer Maintenance
962 Miscellaneous Services
964 Employment Agency Service (Temporary Personnel)
966 Printing, Silk Screen Printing and Typesetting
968 Public Works
971 Rent/Lease Facilities
975 Rent/Lease Equipment
988 Services: Ground Areas
990 Services: Security, Fire and Safety
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