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L?h? l@h@ JhAhA NBhB pBhBBh$B xCBh xxxxxxxCrCh xxxCh0C x$Dh&D xxxxxJDh(D xxDh(D xxxxDh(D xxxxxxxx>Gh0G `vGh(GwzGh(G HhHxxxcHhDH xx`_h0_w_h0_ xxxxxxxxxxxxxx`h0` xxxxxxxxxc(chgc CONTENTSXCompObj ^SummaryInformation( DocumentSummaryInformation8CHNKINK &TEXTTEXTCSTSHSTSHE(STSHSTSH F$STSHSTSHDIFDPPFDPPLFDPPFDPPNFDPPFDPPPFDPCFDPCRFDPCFDPCTFDPCFDPCVFDPCFDPCXFDPCFDPCZFDPCFDPC\FDPCFDPC^FDPCFDPC`FDPCFDPCbFDPC FDPCdFDPC FDPCfFDPC FDPChHAVE YOU MOVED? PROVIDENCE SCHOOL DEPARTMENT CHANGE OF ADDRESS FORM Please provide accurate contact information so that mailings and telephone messages can be delivered reliably and on-time. One proof of residency (original or certified copy), dated within the past 60 days, must be provided in order to change your address. Please check the proof of residency document you are submitting with this notice: % Lease/rental agreement % Residential property bill % Utility Bill (gas, electric, cable) (Section 8 Agreement) % Pay Stub % Bank Account Statement RESIDENCY QUESTIONNAIRE The Education of Students in Homeless Situation s in the 2001 No Child Left Behind Act: Summary of McKinney-Vento Act and Title I Provisions. The McKinney-Vento Homeless Assistance Act, reauthorized in December 2001, ensures educational rights and protections for children and youth experiencing homelessness. This document summarizes key provisions of the Act, as well as key provisions of the reauthorized Elementary and Secondary Educations Act s Title I statute. A copy of the full test of the legislation is available the following websites: http://www2.ed.gov/policy/elsec/leg/esea02/pg116.html or www.nlchp.org. Please identify the student s current living arrangements by checking one of the boxes below: % With another family or other person because of loss of housing or as a result of economic hardship % Emergency trailer park, care, campground, park public places, abandoned building, street, or any other inadequate living space. % Hotel or motel ( that is NOT an emergency or transitional shelter and involves payment). % With an adult who is not a parent or guardian, or alone without an adult. % Emergency or transitional shelter. % Permanent housing. SE HA MUDADO? FORMULARIO DE CAMBIO DE DIRECCION DEL DEPARTMENTO ESCOLAR DE PROVIDENCE Favor de proveer la correcta informacin de contacto para que pueda recibir todas las correspondencias y mensajes telefnicos de manera segura y precisa. Se requiere una prueba de direccin (original, o copia certificada), que incluya una fecha dentro de los ltimos 60 das, para poder cambiar su direccin domiciliar. Favor de marcar el documento que incluir con este formulario como prueba de direccin: % Contrato de Arrendamiento % Factura (bill) de su propiedad % Facture de utilidad (gas, luz, telfono, cable) (Contrato de Seccin 8) Talonario de pago % Estado de cuenta bancario CUESTIONARIO DE DIRECCION DOMICILIAR La Educacin de Estudiantes que sufren de Casos de Desamparo (Homeless) de acuerdo a la Ley Federal Que Ningn Nio Se Quede Atrs del 2001: Resumen de la Ley McKinney-Vento y Provisiones de Titulo I. La Ley Federa Educacional para Familias Desamparadas McKinney-Vento, reautorizada en diciembre de 2001, les asegura derechos educativos y proteccin a los nios y adolescentes desamparados. Este documento provee un resumen de las provisiones claves de dicha ley, como tambin las provisiones claves del estatus de Titulo I de la Ley reautorizada de Educacin Primaria y Secundaria. Una copia de la legislacin complete est disponible en las siguientes pginas web: http://www2.ed.gov/policy/elsec/leg/esea02/pg116.html or www.nlchp.org. Favor de indicar las condiciones de vivienda actual del estudiante al marcar una de las casillas abajo: % Con otra familia o persona debido a la perdida de domicilio o dificultades financieras. % Campamento de Casas Rodantes, carro, campamento, parque, lugares, pblicos, edificio abandonando, calle o cualquier otro lugar inadecuado. % Hotel o motel ( que NO sea un refugio de transicin de emergencia e incluya pago de renta). % Con un adulto que no es el padre o encargado, o solo, sin un adulto. % Casa de refugio de emergencia. % Domicilio permanente. 325 Ocean Street " Providence " Rhode Island " 02905 " Telephone:401-456-9297 " Fax: 401-278-0553 11/16 325 Ocean Street " Providence " Rhode Island " 02905 " Telephone:401-456-9297 " Fax: 401-278-0553 11/16 Please list the information below for each students in the household currently attending PPSD. For office use only 1. _____________________ ______________________ _____/_____/______ _____________ % Yes % No Student Last Name Student Frist Name Date of Birth Entity Transportation 2. _____________________ ______________________ _____/_____/______ _____________ % Yes % No Student Last Name Student Frist Name Date of Birth Entity Transportation 3. _____________________ ______________________ _____/_____/______ _____________ % Yes % No Student Last Name Student Frist Name Date of Birth Entity Transportation 4. _____________________ ______________________ _____/_____/______ _____________ % Yes % No Student Last Name Student Frist Name Date of Birth Entity Transportation 5. _____________________ ______________________ _____/_____/______ _____________ % Yes % No Student Last Name Student Frist Name Date of Birth Entity Transportation New Address: (In the space provided below, please list the address which you matches the document you have provided.) Previous Address: (In the space provided below, please list the address which you recently have vacated.) ____________ _______________________________________ ____________ _____________________________________ House Number Street Name House Number Street Name _________________________ __________________ _________________________ _______________ % Apt. % Flr. % Unit % Left % Right % Rear Zip Code Parent/Guardian Information: ____________________________ ________________________ ( ) _____________- _________________ Last Name First Name Primary Telephone Number Falsification of address/conditions of living arrangement to obtain a school assignment will be cause for the revocation of the student s school assignments. Signature of Parent/Guardian: __________________________________________________________ Date: _______/_______/_______ % Apt. % Flr. % Unit % Left % Right % Rear Zip Code Favor de completar la informacin para cada estudiante en el domicilio cual asiste a PPSD. For office use only 1. ________________________ __________________________ ______/_______/______ _____________ % Yes % No Apellido Nombre Fecha de Nacimiento Entity Transportation 2. ________________________ __________________________ ______/_______/______ _____________ % Yes % No Apellido Nombre Fecha de Nacimiento Entity Transportation 3. ________________________ __________________________ ______/_______/______ _____________ % Yes % No Apellido Nombre Fecha de Nacimiento Entity Transportation 4. ________________________ __________________________ ______/_______/______ _____________ % Yes % No Apellido Nombre Fecha de Nacimiento Entity Transportation 5. ________________________ __________________________ ______/_______/______ _____________ % Yes % No Apellido Nombre Fecha de Nacimiento Entity Transportation Nueva Direccin: (En los siguientes espacios prueba la direccin cual es igual al documento que has provedo.) Direccin Anterior: (En las siguientes lneas prueba la direccin cual usted acaba de desalojar.) ____________ _______________________________________ ____________ _____________________________________ Numero de Casa nombre de calle/avenida domiciliar Numero de Casa nombre de calle/avenida domiciliar _________________________ __________________ _________________________ __________________ %Apt. %Piso. %Unidad % Izq. Cdigo Postal %Derecha %Parte Atrs %Apt. %Piso. %Unidad % Izq. Cdigo Postal %Derecha %Parte Atrs Informacin del Padre/Tutor: _______________________________________ _____________________________ ( ) _________ - ___________ Apellido Nombre Telfono Principal La falsificacin de direccin/condiciones de vivienda para obtener una asignacin escolar resultar en la cancelacin de la asignacin de la asignacin escolar del estudiante. 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