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2026-2027 McKinney-Vento Declaration Form

Tulare City School District

Student Residence Questionnaire

2026/2027

McKinney-Vento Assistance Act – Declaration Form

***ONLY ONE FORM PER FAMILY NEEDS TO BE COMPLETED***

This questionnaire is intended to address the McKinney-Vento Act, authorized by the Every Student Succeeds Act. (Dec. 2015) Your answers will help determine residency and/or documents necessary for your student enrollment and eligibility for federal services available to qualified students. The information you provide will not be shared with outside agencies. This information may be shared with other California schools should your child transfer out of TCSD.

Currently, where does your child/family reside? PLEASE CHECK ONLY ONE

Answer required for "Currently, where does your child/family reside? PLEASE CHECK ONLY ONE "

(STABLE AND PERMANENT) Live in a single-family residence (home, house, apartment, or dwelling), which means that the building is usually occupied by just one family or household.

(SHARING BY CHOICE) Live with another family in a home, house, apartment, or dwelling NOT due to financial hardship.

(SHARING DUE TO FINANCIAL HARDSHIP) Live temporarily with a friend or relative because of financial hardship and/or loss of housing

Live in a motel, hotel, or weekly rate housing.

Live in an emergency shelter, transitional shelter, or domestic violence shelter.

Live in a car, trailer park, or campground

Foster child awaiting placement

Migratory child/children living in a Labor Camp

Living in substandard housing is defined as residential structures that do not meet local health and safety requirements. (Shed, garage, tent, or structure not meant for human habitation; i.e., no electricity, running water, or cooling/heating)

Contact Information

Name of Parent/Guardian

Answer required for "Name of Parent/Guardian"

Addresss

Answer required for "Addresss"

Home Phone

Number Required

Mobile Phone

Number Required

Emergency Contact Name

Answer required for "Emergency Contact Name"

Emergency Contact Phone

Number Required

Please list the first and last name of the child/children YOU are the parent or guardian of: I declare under penalty of perjury under the laws of the State of California that the above information is a true and accurate account of my residential status. I understand that the information on this document is subject to District verification, and home contacts may be made to establish accuracy. I further understand that fraudulent and misrepresentation of the above data may be grounds for denial of my student’s enrollment at the school(s) I have listed. Additionally, if the information on this document is found to be fraudulent, my child will be immediately withdrawn from the school(s) stated above and will be required to enroll, within two school days, in their correct school of residence.

Student Information

Student Name, Birthday, School, Grade*

Answer required for "Student Name, Birthday, School, Grade"

Student Name, Birthday, School, Grade

Answer required for "Student Name, Birthday, School, Grade"

Student Name, Birthday, School, Grade

Answer required for "Student Name, Birthday, School, Grade"

Student Name, Birthday, School, Grade

Answer required for "Student Name, Birthday, School, Grade"

My signature below indicates I have read the above statement and understand the conditions.*

Signature Required

If you have any questions, please contact TCSD’s Homeless Liaison

Stephanie Mendonca – [email protected] – 559-685-7222

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"