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.

Select the statements that best describe your present housing situation.

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Name of Guardian/Caregiver

Are you the Legal Guardian of the student you are enrolling?*

Check this box if you have a legal copy of custody documentation if you are not the biological parent.

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

Immediately prior to going to your current address, were you evicted?*

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

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Gender*

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

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Is the student in gifted or advanced placement classes?*
Does the student have a current IEP (Special Education)?*
Do you have a copy of the IEP and MFE?*

If yes, please upload below.

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Does the student have a 504 Plan or medical plan?*

Also, please upload below.

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Did the student learn to speak a first language other than English?*
Does the student speak a language other than English?*
Is the language most often spoken in the child’s home one other than English regardless of the language spoken by the child?*

Select the last school the student attended.

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Prior School Attended

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

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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.

Picture Permission*

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!

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