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Example Forms and Documentation

Examples of Forms and Documents Created by Districts and Other Agencies

 

Public and Staff Awareness

PowerPoints and other training resources are available on our Training Resources page

Annual Notice

DPI ConnectED Article "Supporting Students Experiencing Homelessness"

Free posters and brochures are available from the National Center for Homeless Education (NCHE)

Families in Transition McKinney-Vento Brochure and Familias en Transición McKinney-Vento Ley de Educación para Desamparados 
Racine Unified School District

Transitional Education Program Brochure
Middleton-Cross Plains Area School District

Community Coordination and Collaboration

Parkview School District Letter to Community Organizations

Identification and Referral

Homeless Eligibility Flowchart, 2017

Sample Questions to Ask the Students or Parents for Information Gathering
The following questions are designed to assist in gathering information from families or youth to determine the extent to which their living arrangement is fixed, regular, and adequate.

Homeless Student Identification Form for local use - Microsoft Word
Fillable Homeless Student Identification Form for local use - PDF

WIAA Eligibility Form

Student/Family Residence Questionnaire
The Madison Metropolitan School District has developed a Student/Family Residence Questionnaire form to determine eligibility for services.

Family Data Sheet
Residence Questionnaire
Ashwaubenon School District

Families in Transition Questionnaire and Cuestionario de Familias en Transición
Racine Unified School District

Identification and Transportation for Students - MCPASD Transitional Education Program
The Middleton-Cross Plains Area School District has developed a transitional education service plan form to track student services.

Consent to Release Confidential Information and Permiso para Obtener y Divulgar Informatión
Middleton-Cross Plain Area School District

Education for Homeless Children and Youth (EHCY) Family Data Sheet
Ashwaubenon School District

County Resource Guides can be obtained through UW Extension or local Health and Human Services agencies. 

Policies and Procedures

McKinney-Vento Homeless Program and Guidelines and Procedures
Kimberly Area School District

Sample District Policy and Procedure for McKinney-Vento: Appleton School District
The Appleton Area School District's homeless policy and procedure.

District Homeless Policy and Procedure
The Tomahawk School District's homeless policy and procedure.

Homeless Liaison Tool Kit
National Center for Homeless Education (NCHE)

Transportation to and from the School of Origin

Personal Service Contract
Janesville contracts with an individual to provide transportation for preschool and elementary students who are homeless. Janesville has been able to eliminate the use of taxicabs. This contract is between the school district and the individual who provides transportation.

Gas Card Agreement
Janesville School District

Madison Metropolitan School District’s Homeless Transportation Agreement form
This form can serve as model for coordinating transportation in your district.

Middleton-Cross Plains Area School District’s Transportation Inter-district Agreement
Middleton’s agreement can serve as a model for a transportation agreement.

Middleton-Cross Plains Area School District’s Parent Transportation Contract

Gas Card Agreement 
Ashwaubenon School District

Gas Card Agreement; Gas Card Calculation; and City Bus Pass Agreement
Racine Unified School District

Immediate Enrollment

Release of Information Form
Middleton-Cross Plains Area School District

Affidavit Form for Missing Enrollment Documentation
National Center for Homeless Education (NCHE)

Parent Permission to Obtain or Release Information
Dodgeville School District

Sample Caregiver Form
National Center for Homeless Education (NCHE)

Dispute Resolution

Homeless Dispute Resolution Form
South Milwaukee School District

Families in Transition Dispute Process and forms for escalation of dispute - Level 2, Level 3, and Level 4
Racine Unified School District

Student Placement Dispute ProcessStudent Placement Dispute Form; and Notification of Student Placement Dispute Resolution
Ashwaubenon School District

For questions about this information, please contact our State EHCY Coordinators Kristine Nadolski at (608) 267-7338 and Karen Rice at (608) 267-1284.