Documents Created by DPI and Sample Documents
Local Use Form Homeless Student Identification (PI-Q03-8)
Authorization for Release or Exchange of Information
Community Information Directory
How to Fill Out the Community Information Directory Template Directions
Sample Newsletter Article:Families and Students in TransitionSample Outreach Form:Information for Shelter Staff
WIAA Homeless Eligibility Form
Examples of Forms Created by Districts
This section provides examples of various forms created by districts. These forms are not required by DPI. Rather, they are tools districts can use to improve McKinney-Vento services.
District Homeless Policy and Procedure
The Tomahawk School District's homeless policy and procedure.
Student/Family Residence Questionnaire
The Madison Metropolitan School District has developed a Student/Family Residence Questionnaire form to determine eligibility for services.
Transitional Education Service Plan
The Middleton/Cross Plains School District has developed a transitional education service plan form to keep track of homeless students.
McKinney-Vento Homeless Referral Form
This form was developed by Cooperative Educational Service Agency (CESA) 11.
School District of Janesville’s 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.
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
Ashwaubenon Gas Card Agreement
Ashwaubenon Voluntary Survey
Ashwaubenon School District, 2009. This survey can be completed upon enrollment to help district staff determine if a student is eligible for McKinney-Vento services.
Self Identification Form for Homeless and Highly Mobile Students
Minneapolis Public Schools, 2007.
Shawano School District: Student Residency Questionnaire
School Selection Form
This form was created by CESA 11.
For questions about this information please contact one of our State EHCY Coordinators: Lara Kain (608) 267-7338 or Carolyn Parkinson (608) 267-1284