BIG RAPIDS

Enter student data in the form below:

2016-17 Big Rapids

Use this form to enter Homeless Student data for students attending your district.

SECT. 1 STUDENT INFORMATION
Help for Student's First Name Please enter the student's first name.
Help for Student's Last Name Enter the Student's Last Name
mm/dd/yyyy
Help for Gender Select the student's gender
Help for Grade Level Select the appropriate grade level
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SECT. 2 ELIGIBILITY AND SCHOOL SELECTION
Help for Date ID as Homeless Select the date this student was identified as homeless mm/dd/yyyy
Help for Date Student Left the District If the student left the district, please add the date here--remember this may be information you will enter later in the year using your secure login at www.moisd.org/admin mm/dd/yyyy
Help for Is this student an unaccompanied youth? Is this student in the custody of a legal guardian?
Help for Is this a foster care student? You must indicate if this is a student that is in foster care.
Help for If this is a foster care student,in current placement for <6 mo., indicate the date placed into care. You may want to put a reminder in your calendar of the date transportation support will end for this student--notice of the termination of this support should go to the family 30 days prior to ending these services. Remember that effective December 10, 2016 DHHS/Foster Care will be responsible for all transportation of students in Foster Care. Beginning January 1, 2017 we no longer include new foster care students in our homeless count. mm/dd/yyyy
Help for School of Origin Write in the school attended by this student most recently.
Help for District of Residence Please enter the school district where the student currently lives.
Help for First day of Attendance Select the date this student first attended classes. This may not be the same date student enrolled. Often this will be the first day of the current academic year. mm/dd/yyyy
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SECT. 3 STUDENT CHARACTERISTICS AND ENROLLED PROGRAMS
Characteristics  (required) Help for Characteristics Select as many of the following that apply for this student.
Enrolled Programs  (required) Help for Enrolled Programs Select from any of the programs below. Check any that apply for this student.
Help for Nighttime Residence Select the primary nighttime residence for this student. Numbers correspond to codes in MSDS collected by CEPI.
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SECT. 4 TITLE I INFORMATION
Help for Student is attending school that is Title I funded Please indicated if the building the student is attending receives Title I funds.
Help for Student receives Title I Services Does this student receive Title I services?
Help for Title Services Received Please list all services received by this student that are directly tied to Title I supports, services, programs, or funding.
Help for If not receiving Title I services please explain. All homeless students are eligible for Title I comparable services even if not in a building that receives Title I funding.
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SECT. 5 SERVICES AND REFERRALS PROVIDED BY YOUR DISTRICT FOR THIS STUDENT (SELECT ALL THAT APPLY):
School Services  (required) Help for School Services Select all that apply
Help for Comments District Services Provide additional information here.
Community Referrals  (required)
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SECT. 6 FEES: PLEASE INDICATE FEES PAID FOR THIS STUDENT
Fees  (required) Help for Fees Fees paid using District set-aside funds, Title funds or General fund dollars.
Help for Comment Fees Provide additional information here.
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SECT. 7 TRANSPORTATION--WITHIN AND CROSS DISTRICT (2 SECTIONS)
WITHIN DistrictTransportation  (required) Help for WITHIN DistrictTransportation How was transportation addressed for this student?
CROSS District Transportation-when student resides outside the district. Help for CROSS District Transportation-when student resides outside the district. Use this section when transportation happens across district lines.
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SECT. 8 BARRIERS
Barriers  (required) Help for Barriers What difficulties did you experience while working with this student? Select all that apply!
Help for Comment Barrier Provide additional information here.
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SECT. 9 THE FOLLOWING ITEMS ARE TO ENSURE COMPLIANCE WITH MCKINNEY-VENTO LAW
Help for I have informed this family/student of their rights under McKinney-Vento law. http://center.serve.org/nche/downloads/parentbrochure_eng.pdf
Help for Student has been included in our district's pupil accounting system and is coded as homeless Select the most appropriate response. If the student is not age eligible to attend school, yet you have identified an older school age child you would select
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Help for My district's Dispute Resolution process was provided to this student/family? Please indicate if you provided your districts DR process to this family/student.
Upload a copy of any placement or service decision letters here along with the Dispute Resolution. Help for Upload a copy of any placement or service decision letters here along with the Dispute Resolution. Upload these documents for auditing purposes.
Filename Size Status
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SECT. 10 PLEASE ENTER THE FOLLOWING INFORMATION ABOUT YOURSELF:
Help for Email Add your email here.
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For Internal Use Only: Liaison Signature and Date for Approval of Homeless Designation
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