Survey For Homeless Children and Youth
LEA's WITHOUT McKinney -Vento Sub-grants


Please provide the following information requested pursuant to Title VII, Subtitle B, Section 722 (d) of the Steward B. McKinney Homeless Assistance Act.

Homeless Liaison:
Email:
Phone:


I. NUMBER OF HOMELESS CHILDREN AND YOUTH
   Provide the number of homeless children and youth in your district enrolled in public school during the current school year.

School Level Number of Homeless Enrolled in Public School
Age 3 through 5 (not Kindergarten)
K
1
2
3
4
5
6
7
8
9
10
11
12
Ungraded (e.g. primary groupings, groupings with learning disabilities, etc. Not students temporarily or more permanently residing as incarcerated in a facility.)


II. PRIMARY NIGHT TIME RESIDENCE OF HOMELESS CHILDREN AND YOUTH
   Of the total number of homeless children and youth, (excluding preschoolers), provide the numbers who had the following as their primary nighttime residence at the time of initial identification by LEAs.

Primary Night Time Residence Number
Shelters
Doubled-up 1)
Unsheltered 2) (e.g., cars, parks, campgrounds, etc.)
Hotels/Motels

1 Children and youth (including runaway youth or unaccompanied youth) who live with relatives or friends due to being homeless may be categorized as Doubled-up.
2 Children and youth living in abandoned buildings, campgrounds and vehicles, bus stations, substandard or inadequate housing may be categorized as Unsheltered.


I hereby certify that by approving this document it is meant that the information
provided is complete and accurate, and that supporting documents are available for inspection.