Title VII McKinney-Vento 2001 Law – David G. Russell, Title VII Liaison, Tel. #203- 937-4300 x 7126 Fax 932-0572 – Date: Person completing form: Name of Student Current Address:_________________________________Phone Living with:_______________________________ Relationship to Student Last Attended School: Last Attended Grade: Last West Haven Address: Current School: Current Grade:____________ Mother:_________________________________ Father: Address:________________________________ Address: Phone:_________________________________ Phone : Transportation Needs Transportation Plan: Description of Services Needed Food Services: Meg Kingston Parent Liaison: Dave Russell, x 7126 Social Worker Guidance Counselor/SW Nursing Supervisor: Donna Kosiorowski School Nurse: Academic Program Contact: Services Terminated:________________________ Reason: Moved No Longer Considered Homeless
Title VII – McKinney-Vento 2001 Law David G. Russell, Title VII Liaison, Tel. #203- 937-4300 x 7126 – Fax 932-0572 Date: Person completing form: Name of Student Current Address:_________________________________Phone Living with:_______________________________ Relationship to Student Last Attended School: Last Attended Grade: Last West Haven Address: Current School: Current Grade:____________ Mother:_________________________________ Father: Address:________________________________ Address: Phone:_________________________________ Phone : Transportation Needs Transportation Plan: Description of Services Needed Food Services: Meg Kingston Parent Liaison: Dave Russell, x 7126 Social Worker Guidance Counselor/SW Nursing Supervisor: Donna Kosiorowski School Nurse: Academic Program Contact: Services Terminated:________________________ Reason: Moved No Longer Considered Homeless