STUDENTS IN TRANSITION (SIT) PROGRAM

STUDENTS IN TRANSITION (SIT) PROGRAM

The Pasco County School District wants to make sure that your child receives the best possible education. The information from this form will help to determine if your student is able to receive benefits under the federal McKinney-Vento Act, a law that helps students who are temporarily displaced from their home for certain reasons. Specific rights are listed on the next page.

A student qualifies for the McKinney-Vento Act if they are between the ages of 0-22 and lack a fixed, regular and adequate nighttime residence. Specifically, if a student lives under any of these conditions:
• a house or apartment with more than one family because of economic hardship or loss
• a shelter (family, youth or domestic violence shelter or transitional living program)
• a motel, hotel or weekly rate housing
• an abandoned building, in a car, at a campground, on the street, etc.
• substandard housing (without electricity, heat or water)
• with friends or family because the youth is a runaway or unaccompanied youth

PLEASE DO NOT complete this form if your housing DOES NOT meet one of the conditions listed above. If you rent, share housing for convenience, or if you are buying a house and do not need support services, your students DO NOT qualify for the McKinney-Vento Act.

STUDENT INFORMATION:

School-Aged AND Non School-Aged Children - List ALL children in your family
How many children are in the household?:
Student #1:
Name: Name: First Last
DOB: DOB: / MM / DD YYYY
Sex:

Sex: Male Female
Student ID:
School:
Grade:
(OTHER) Name of school, County and State
Student #2:
Name: Name: First Last
DOB: DOB: / MM / DD YYYY
Sex:

Sex: Male Female
Student ID:
School:
Grade:
(OTHER) Name of school, County and State
Student #3:
Name: Name: First Last
DOB: DOB: / MM / DD YYYY
Sex:

Sex: Male Female
Student ID:
School:
Grade:
(OTHER) Name of school, County and State
Student #4:
Name: Name: First Last
DOB: DOB: / MM / DD YYYY
Sex:

Sex: Male Female
Student ID:
School:
Grade:
(OTHER) Name of school, County and State
Student #5:
Name: Name: First Last
DOB: DOB: / MM / DD YYYY
Sex:

Sex: Male Female
Student ID:
School:
Grade:
(OTHER) Name of school, County and State
Student #6:
Name: Name: First Last
DOB: DOB: / MM / DD YYYY
Sex:

Sex: Male Female
Student ID:
School:
Grade:
(OTHER) Name of school, County and State
Student #7:
Name: Name: First Last
DOB: DOB: / MM / DD YYYY
Sex:

Sex: Male Female
Student ID:
School:
Grade:
(OTHER) Name of school, County and State
HOUSING INFORMATION:
Where is/are the student(s) living at this time?:

Where is/are the student(s) living at this time?: An emergency or transitional shelter (A) Temporarily with another family due to loss of housing, economic hardship or similar reason (B) A vehicle of any kind, trailer park or campground, abandoned building or other substandard housing (D) A hotel/motel due to loss of housing, economic hardship or similar reason (E)
Reason for temporary living: (If due to COVID-19, please select all that apply):

Reason for temporary living: (If due to COVID-19, please select all that apply): Foreclosure (M) Tornado (T) Flooding (F) Eviction Fire (W) Earthquake (E) Unemployment (O) Wildfire (W) Tropical Storm (S) COVID-19 (P) Man Made Disaster (D) Hurricane (H) Other Other
Tropical Storm Name:
Hurricane Name:
The student(s) is/are:

The student(s) is/are: in the physical custody of a parent or legal guardian NOT in the physical custody of a parent or legal guardian (ex: living alone, with a relative who is not their legal guardian, living with other people, etc.) .
Student Contact Information for Unaccompanied Youth:
Email
Phone Phone - ### - ### ####
PARENT/LEGAL GUARDIAN/CAREGIVER CONTACT INFORMATION
Parent/Legal Guardian/Caregiver Name: Parent/Legal Guardian/Caregiver Name: First Last
Relationship to student:
Temporary address or location of housing: Temporary address or location of housing:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone: Cell Phone: - ### - ### ####
Alt Phone: Alt Phone: - ### - ### ####
Email:
Primary Language Spoken:
How long has/have the student(s) been in the TEMPORARY place?:
Student is in School Zone:

Student is in School Zone: YES NO

If student is living in school zone a bus can be requested through your school staff.
SIT Bus Required:

SIT Bus Required: YES NO
SIGNATURES
The undersigned certifies that the information provided is accurate.

Florida Statute 837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his/her official duty shall be guilty of a misdemeanor of the second degree.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Name of the Person Completing This Form: Name of the Person Completing This Form: First Last
Today's Date Today's Date / MM / DD YYYY

Date the form is submitted
Email of the Person Completing This Form

Use if you would like a copy of the completed form for your records
PARENT/STUDENT RIGHTS PAGE

Parents/Student Rights Page Provided (Please keep a copy of the Parent/Student Rights page)

When finished please scroll to the bottom of the form and press "Submit":
I have read the page above