102 Loralee Drive
Albany, New York 12205
South Colonie
C E N T R A L S C H O O L D I S T R I C T
Enrollment Form
Phone
Fax:
(518) 869-3576 ext 0454
1(833) 961-1185
Residency Questionnaire
McKinney–Vento Assistance Act
The McKinney–Vento Assistance Act of 1987 is a federal law that provides money for homeless shelter programs.
_South Colonie Schools_____________
Name of School
Gender:
Where is the student currently living? (Please check one given below.)
In an emergency or transitional shelter
With another family or other person due to loss of housing or economic hardship
With an adult who is not a parent or guardian or alone without an adult
In a hotel/motel
In a car, park, bus, train, campsite, public place, abandoned building
Other temporary living situation (Please describe) _______________________________
Print name
Date _____________________
_________________________________ ________________________________________
of Parent, Guardian, or Student
________________________________
Name of Student
________________________________
Address: __________________________________________ Phone _____________
Signature
of Parent, Guardian, or Student
If the student is NOT living in permanent housing, please ensure that a Designation Form is completed.
CONFIDENTIAL INFORMATION
No, the student is residing in permanent housing.
If the student is not living in permanent housing, proof of residency and other documents
normally needed for enrollment are not required and the student is to be immediately
enrolled. After the student has been enrolled, the district/school must contact the
previous district/school attended to request the student’s educational records, including
immunization records, and the enrolling district’s LEA liaison must help the student get
any other necessary documents or immunizations.
NOTE TO SCHOOLS/LEAS:
Date of Birth _____/_____/ _______ Grade _______
M
F
Tuesday, September 27, 2016
South Colonie School District
Change of Address
102 Loralee Drive, Albany, NY 12205 (518) 869-3576 ext 0454
*Please Print
Name of Student(s)
_________________________________________________________________________________________
Old Address of student(s)
_________________________________________________________________________________________
New Address of student(s)
_________________________________________________________________________________________
Phone #:_________________________________
If there has been a change in primary custody explain below -
_________________________________________________________________________________________
List any changes in emergency contact below (provide only if new)
Name________________________________________________________ Phone_______________________
Name________________________________________________________ Phone_______________________
Moving from ________________________________ School to _________________________________ School.
*** Three proofs of the new address need to be provided with this form.
Parent Signature ______________________________________________________ Date__________________
Administrator Signature ________________________________________________ Date__________________
_________________________________________________________________________________________
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