Students and Families in Transition Assistance Form

* Asterisk = Required field

Today's Date Today's Date / MM / DD YYYY
1 - Do you rent/own your own home?

1 - Do you rent/own your own home? Yes (if you answered yes, please do not continue completing form) No (if you answered no, please continue with assistance form)
2 - What is your current living situation?

2 - What is your current living situation? Temporarily with another family due to loss of housing, economic hardship, or similar reason In an emergency/transitional shelter In a vehicle of any type, trailer park or campground, abandoned building or other substandard housing In a hotel/motel due to loss of housing, economic hardship, or similar reason Other Other
3 - What is the cause of your current living situation?

3 - What is the cause of your current living situation? Foreclosure Eviction Unemployment Divorce House Fire Flood Hurricane COVID-19 Other - Please explain Other - Please explain
4 - If you are a student - Are you alone without an adult or with an adult that is NOT a parent or legal guardian?

4 - If you are a student - Are you alone without an adult or with an adult that is NOT a parent or legal guardian? Yes No
5 - Please provide your contact information to receive additional information about additional educational services.

Your Name
Phone Phone - ### - ### ####
Email
Address (if one is available) Address (if one is available)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
6 - Name of Student (The name of only one student is necessary) 6 - Name of Student (The name of only one student is necessary) First Last
7 - What school does that student currently attend?