Dear Faculty & Staff,

Please take a moment to read and complete the following survey. If you do not know a student who currently is living or has lived in any of the situations described below, there is a form for you to sign in lieu of completing this survey. (Please check with the office staff if you do not know where this form is posted at your school.) This information is needed for compliance with federal law and to ensure that our students are receiving all of the services to which they are entitled. Thank you in advance for your time and cooperation in completing this survey.

All surveys should be completed no later than Wednesday, March 9th.
Please read the following carefully and identify students who are, or have been, in any of the following situations THIS school year. Please include pertinent information when possible.

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* 1. Faculty/Staff Member's Name

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* 2. Date

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* 3. Primary School Assignment

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* 4. Primary position or grade level served

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* 5. Are you aware of students at your school who temporarilty live or have lived with another family (relative or friend) this school year because they had nowhere else to go?

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* 6. Are you aware of students at your school who currently live or have lived in a motel or hotel this school year?

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* 7. Are you aware of students at your school who currently stay or have stayed at a local shelter this school year (SAFE House, Safe Place program at Link House, Hope Haven Ministries for Women & Children, or the Interfaith Hospitality Network of Greater Kingsport)?

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* 8. Are you aware of students at your school who are at risk of being evicted from their homes within a week or whose homes are in foreclosure?

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* 9. Are you aware of students at your school who live in substandard conditions (i.e. homes without electricity or water for an extended period of time)?

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* 10. Are you aware of students at your school who were thrown out of their home, ran away, or willingly left home this school year and currently live or have lived in any of the situations described above?

If you answered "yes" to any of these questions, then you probably work with students who are eligible to receive certain services through our school system's Homeless Education Program.
Please remember that student confidentiality is paramount and only those directly involved with the student or in an administrative position should know about the student's situation.

For more information about the educational rights of homeless children & youth—please read the National Law Center on Homelessness & Poverty’s publication “Education of Homeless Children & Youth: The Guide to Their Rights” at http://www.nlchp.org/Education_of_Homeless_Children_and_Youth

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