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Caregiver Authorization Form

 

Handle: Document-35863
Owner: Geveshausen, Olivia (User-6386, 15414:EVERETT)DS
Friday, August 26, 2011 09:17:10 AM PDT
Thursday, January 16, 2025 12:57:00 PM PST
Modified By: Geveshausen, Olivia (User-6386, 15414:EVERETT)DS
Locked By:
  • This form is intended to address the McKinney-Vento Homeless Assistance Act (P.L.
  • 107-110)
requirement that homeless children have access to education and other services for which they areeligible.
  • Instructions:
Complete this form for a child/ youth presenting himself/ herself for enrollment while not in the physicalcustody of a parent or guardian.
  • I am 18 years of age or older and have agreed to fulfill the role of caregiver for the minor named below.
  • I declare that the foregoing information is true and correct.
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
Caregiver Authorization Form.pdf
No
4
217681
No
Appears In: Kids In Transition
Preferred Version: Caregiver Authorization Form