2023-2024 Project ACT Parent/Caregiver Homeless Enrollment Form

Welcome to Project ACT. We are here to assist you. Please complete all questions on the form.


For each student to be enrolled today, you will need to complete an individual form. Once you have completed a form for each of your children, please take a seat, and you will be called to see a staff member in order in which you have arrived.

 
 
mm/dd/yyyy
 

Select the statements that best describe your present housing situation.

 

Name of Guardian/Caregiver

 
 

Address where the student is staying? Please be sure to include the Zip Code!

 
 
 
 
 
 

Have you been recently evicted?

 
 
 
 
 
 
 
 

If different from above

 

If different from above.

 

Grade the student will be in during the 23-24 School year

 
 
 
mm/dd/yyyy
 
 
 
 
 

Select regular classroom if student is not in Special Education/Gifted Education

 
 
 
 

Select the last school the student attended.

 
 

Which school would you like the student to be enrolled in for the 23-24 School Year?

 
 
 

Please select the box below if you are interested in counseling services for your student.

 

I give Project ACT Staff permission to interact and work with my student at a school or shelter.

 

May we take pictures of your child interacting in their classroom or other Project ACT Activities?

 

Check this box to give CMSD permission to text to your cell phone number.

 

How many children do you have age two or younger?

 

How many children do you have ages three to five NOT including children enrolled in Kindergarten or preschool.

 

Please attach all documentation in your possession: Birth Certificate, Shot Records, Special Education (IEP & ETR) Documentation, out of district report card/transcript, etc.


You MUST attach your Photo ID. We cannot process enrollment without your Photo ID attached!

Drop your files here