PWCS McKinney-Vento Eligibility Form

THIS ONLINE FORM IS ALSO AVAILABLE IN SPANISH:
CLICK THE WORD "ENGLISH" ON TOP RIGHT-HAND CORNER
TO DROP DOWN THE SPANISH OPTION

The PWCS McKinney-Vento (MKV) program provides the following educational rights and benefits to students who meet the homeless definition. The overall goal of MKV is to remove enrollment barriers and offer school stability during a time when the student is experiencing housing instability.

Students who qualify for MKV will receive ...

Immediate school enrollment and attendance with enrollment barriers being removed:
- No residency proof will be required for purposes of school enrollment
  - However, in some situations, the PWCS MKV Liaison has the option to request information/documentation regarding the student's housing situation as needed.
- Students can enroll/attend school without producing birth certificate, physical and/or immunization record at time of immediate enrollment.
  - Birth certificate will need to be provided to the school office within 90 days of enrollment per PWCS regulation. Schools may request that a Birth Certificate Affidavit be completed at the time of immediate enrollment which is permissible. Schools cannot require that the affidavit be notarized as that can be viewed as a barrier.
  - Immunizations/physical must be produced to the school office within 60 days of enrollment per PWCS regulation.
Legal custody is not required for enrollment purposes if a student qualifies for MKV Homeless Unaccompanied Youth (HUY) status.
Automatic approval for free school meals for the remainder of the school year.
Equal access to the same free, appropriate public education (FAPE).
Participation in extracurricular activities for which the student is eligible. (Note: The MKV program is unable to provide special MKV transportation services for extracurricular activities.)
Option of remaining in the same school (aka school of origin) even if the student moves outside of school boundaries and/or into permanent housing during the school year in which the student qualifies for MKV.
School transportation for students to remain in the same school (school of origin) while residing outside of school boundaries during the school year in which the student qualifies for MKV.

The information that you provide on this MKV Eligibility Form helps the PWCS MKV staff to gather the details of the student's housing/family story in order to determine if the situation meets the MKV definition for homelessness. Additional information may be requested. Each student is assessed case-by-case, and the decisions are based on the student's housing information. The MKV status is confidential and FERPA protected.

The MKV status is valid only for the school year in which the student is approved … it does not automatically roll over to the next school year.  If you feel that the student’s situation might qualify for MKV for the next school year, please submit a new MKV Eligibility Form over the summer. The PWCS MKV program starts accepting new Eligibility Forms on July 15th every summer. It is best to submit the form in mid/late July or very early August to avoid the late rush which can slow down the processing time. Additionally, special MKV transportation does not automatically roll over to the next school year. Transportation services must also be requested again.

NOTE: We are experiencing an extremely high number of McKinney-Vento (MKV) Eligibility Forms and MKV Transportation Forms being submitted and we are processing them in the order in which they are received. Once a student is approved for MKV status, then at that time we are able to begin processing transportation requests. If we are able to setup transportation, it generally takes the team 3-5 work days to develop a plan and start services; however, due to the increase in requests, it might take longer.

Complete the following questions for the student(s) to be considered for the PWCS MKV program for this 2025-26 school year ...

TODAY'S DATE *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

STUDENT 1

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

Choose the local/zoned school from the drop-down menu below which serves the address where the student is residing the majority of the school nights: *This question is required.
Since this student is new to PWCS or is a returning student to PWCS (after being withdrawn and attending a different school district), the student needs to enroll in the school that is zoned for the address where the student is residing. You can use our PWCS Find My School (PWCS Find My School (based on address) to determine the local/zoned school.

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

NOTE: School placement will be made according to the student's best interest which is determined by the MKV Liaison. If a student is involved with the Hearings Office and/or has an IEP (special education needs), those programs determine school placement which MKV does not override.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

STUDENT 2 *This question is required.

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

STUDENT 3 *This question is required.

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

STUDENT 4 *This question is required.

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

STUDENT 5 *This question is required.

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

STUDENT 6 *This question is required.

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

STUDENT 7 *This question is required.

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

STUDENT 8 *This question is required.

Student's First Name *This question is required.

Student's Last Name *This question is required.

Student's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar MM/DD/YYYY

Is the student NEW to PWCS or RE-ENROLLING in PWCS (after being withdrawn and attending a different school district) for the 2025-26 school year? *This question is required.

Where and when was this student last enrolled in school? *This question is required.

Name of Previous School
Location of Previous School (city/county & state)
Approximate End Date of Last Enrollment

What is the name of the school that this student is currently enrolled in for 2025-26 in PWCS? *This question is required.

Of the two school options that the MKV program can offer, what is your school preference for this student for 2025-26? (choose one): *This question is required.

PWCS ID Number *This question is required.

unknown? enter 0

Are there school-aged siblings who are also in the same housing situation? *This question is required.

If the preschooler is not currently enrolled in PWCS, do you have concerns about the preschooler's speech and/or development delays?

Yes - there are concerns about the preschooler's speech
Yes - there are concerns about the preschooler's developmental delays
No concerns

Comments

If you have not done so already, please visit the Preschool Programs - Prince William County Public Schools website to learn more information about their program and to access their application. Please let me know if you do reach out to their office. If your child qualifies for MKV, we can help remove enrollment barriers.

If you have not done so already, please reach out to PWCS ChildFind. Information about PWCS ChildFind services can be found on the PWCS Website: Child Find & Eligibility - Prince William County Public Schools. Please let me know if you do reach out to their office. If your child qualifies for MKV, we can help remove enrollment barriers.

If there are younger siblings (NON school aged) in the family in the same housing situation, please list their names and ages:

Space Cell	Child's Name	Child's Age
Child 1	Child 1: Child's Name	Child 1: Child's Age
Child 2	Child 2: Child's Name	Child 2: Child's Age
Child 3	Child 3: Child's Name	Child 3: Child's Age
Child 4	Child 4: Child's Name	Child 4: Child's Age

CONTACT INFORMATION (of parent/custodian/caregiver/HUY student): *This question is required.

First Name of Parent/Custodian/Caregiver/HUY Student *This question is required.

Last Name of Parent/Custodian/Caregiver/HUY Student *This question is required.

Which of the following best describes the relationship to the student(s): *This question is required.

Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.

What is the preferred language for communication for the parent/custodian/caregiver/HUY Student? *This question is required.

Please enter an 'other' value for this selection.

Email Address of Person Listed Above (Parent/Custodian/Caregiver/HUY Student) *This question is required.
NOTE: This is the preferred method of communication with the MKV Staff and Transportation Team. If you do not have an email address, please use an alternative email such as the student's PWCS email (which you may access) or a friend or family member's email address (who is willing to pass on any messages to you).
This question requires a valid email address.

ex: email@pwcs.edu

Comments

Phone Numbers of Person Listed Above (Parent/Custodian/Caregiver/HUY Student) *This question is required.

Cell Phone Number:
Work Phone Number:
Home Phone Number:
If NO Phone, put an "x" in this box:

If a cell phone was provided ... *This question is required.(check all that apply)

The cell phone CAN RECEIVE texts from PWCS Staff
The cell phone CAN RESPOND to texts from PWCS Staff
NO texting ability
No cell phone

Who completed this form? *This question is required.(If you are completing the form on behalf of someone, please be sure that they are aware.)

Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.

CURRENT ADDRESS OF WHERE THE STUDENT(S) IS SLEEPING THE MAJORITY OF SCHOOL NIGHTS:

Street Number & Street Name *This question is required. (include room/suite/unit number if applicable)

City *This question is required.

Zip Code *This question is required. This question requires a valid number format.

If you have a housing or agency case manager, supply their contact information below:

Case Manager's Name:
Case Manager's Agency Name:
Case Manager's Phone:
Case Manager's Email:

Does the student's housing/family situation possibly qualify as a MKV Homeless Unaccompanied Youth (HUY)? *

A MKV HUY student meets the MKV definition for homeless and the STUDENT is NOT residing with his/her parent or court appointed legal custodian due to reasons of hardship.

*This question is required.

A MKV HUY student might be doubling up with friends/family, staying in a hotel/motel/shelter, couch surfing or possibly unsheltered. A MKV HUY student might have chosen to leave their parents/custodian's home due to hardship or could have been asked to leave their parents/custodian's home due to reasons of hardship. Some MKV HUY students might not have the option to reside with their parent/custodian for a variety of reasons/hardships. A HUY student's age can range from early childhood (preschool/headstart) through the age of 21 years old (12th grade).

Link to MKV/HUY Definition: Homelessness - Prince William County Public Schools (pwcs.edu)

If more than one student is listed on this form, specify which student(s) might qualify for Homeless Unaccompanied Youth (HUY) status?

Are the MKV HUY student's parent or court appointed legal custodian aware of the whereabouts of the student? *This question is required.

Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.

Being that the MKV HUY student does not reside with their parent or court appointed legal custodian, explain the whereabouts of the parent or legal custodian? *This question is required.

Explain why the student is not residing with the parent or court appointed legal custodian (i.e., what is preventing the student from residing with parent or legal custodian): *This question is required.

Choose one of the options below which best describes the student's current housing situation: *This question is required.

Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.

Upload a Copy of Hotel/Motel Receipt Here(you can mark out any financial information on the hotel/motel receipt)

File: {{filename}} delete

Explain the student/family's housing journey ... *This question is required.

Where was the student/family residing prior to now and was that previous housing situation stable? *This question is required.

What happened to the previous housing which resulted in the current housing situation? *This question is required.

Describe the current housing situation: *This question is required.

What were the contributing factors to the student/family's previous loss of housing which resulted in the current temporary housing situation? *This question is required.(Note: There must be a hardship which resulted in the previous unexpected loss of housing to be considered for MKV.)

Health/Medical Issues
Humanitarian Crisis in Home Country
Loss of Employment
Natural Disaster
Safety Concerns in Home
Uninhabitable Living Conditions in Home
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

1. If you would like to share additional information about the hardships you checked above, please use the space below:

MKV assesses whether the student's current temporary housing situation is fixed and regular and adequate ... answer the questions below to help the MKV staff assess those aspects... *This question is required.

FIXED = permanent, residence is not subject to change;
REGULAR- = guaranteed to be used on a regular basis;
ADEQUATE = sufficient, safe

Space Cell	Yes	Possibly	No
Is the student/parent listed on a current written lease for the student's housing situation?	Is the student/parent listed on a current written lease for the student's housing situation?: Yes	Is the student/parent listed on a current written lease for the student's housing situation?: Possibly	Is the student/parent listed on a current written lease for the student's housing situation?: No
Is the student permitted to utilize the same current housing situation every night?	Is the student permitted to utilize the same current housing situation every night?: Yes	Is the student permitted to utilize the same current housing situation every night?: Possibly	Is the student permitted to utilize the same current housing situation every night?: No
Do the conditions of the current housing situation feel over-crowded?	Do the conditions of the current housing situation feel over-crowded?: Yes	Do the conditions of the current housing situation feel over-crowded?: Possibly	Do the conditions of the current housing situation feel over-crowded?: No
Does the student have a private place to be in the current housing when needed?	Does the student have a private place to be in the current housing when needed?: Yes	Does the student have a private place to be in the current housing when needed?: Possibly	Does the student have a private place to be in the current housing when needed?: No
Does the student have access to a common area in the current home?	Does the student have access to a common area in the current home?: Yes	Does the student have access to a common area in the current home?: Possibly	Does the student have access to a common area in the current home?: No
Does the student/family feel safe in the current housing situation?	Does the student/family feel safe in the current housing situation?: Yes	Does the student/family feel safe in the current housing situation?: Possibly	Does the student/family feel safe in the current housing situation?: No
Are the conditions of the current housing situation in good condition?	Are the conditions of the current housing situation in good condition?: Yes	Are the conditions of the current housing situation in good condition?: Possibly	Are the conditions of the current housing situation in good condition?: No
Does the student/family have access to the kitchen and bathroom at any time?	Does the student/family have access to the kitchen and bathroom at any time?: Yes	Does the student/family have access to the kitchen and bathroom at any time?: Possibly	Does the student/family have access to the kitchen and bathroom at any time?: No
Is there heat, electricity and water available in the current housing situation at all times?	Is there heat, electricity and water available in the current housing situation at all times?: Yes	Is there heat, electricity and water available in the current housing situation at all times?: Possibly	Is there heat, electricity and water available in the current housing situation at all times?: No
Is the student/family searching for another place to live?	Is the student/family searching for another place to live?: Yes	Is the student/family searching for another place to live?: Possibly	Is the student/family searching for another place to live?: No

How long did the student/family reside in the previous housing? *This question is required.

How long has the student/family been residing in the current housing situation? *This question is required.

2. If the student/family has been given a possible leave date, what is the timeframe?

Where will you go if your current housing situation is no longer available? *This question is required.

How many people are residing in the current housing situation? *This question is required.

Where is/are the student(s) sleeping at night in the current housing situation? *This question is required.(check all that apply for the students in the situation)

Bed or Air Mattress - in common space area
Bed or Air Mattress - in private room or room shared with immediate family
Couch - in common space area
Couch - in private room or room shared with immediate family
Floor - in common space area
Floor - private room or room shared with immediate family
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

If the student/family are temporarily doubled-up due to hardship, who is the host home provider?
OPTIONAL - We never want to jeopardize the host home provider's situation so please do not give out information that could put their housing at risk.

Host Home Provider's Name:
Host Home Provider's Address (street number/name):
Host Home Provider's Address (city/state/zip):
Host Home Provider's Email
Host Home Provider's Phone:

Describe the student/family's future housing plans, including time frame: *This question is required.

Check all of the services below that the student(s) needs (if none, check the last box) ... *This question is required.
MKV staff will supply you with the community website that we created to assist you with locating resources for your needs.

School supplies/backpack
School clothing and/or shoes
Food resources
Healthcare resources
Mental health resources
Housing resources
Tutoring services
Other (see the highlighted list below of needs that the MKV program is not able to assist with):
Please enter an 'other' value for this selection. * This question is required.
NO services are requested at this time.

Note: Unfortunately the MKV program does not have funding for:

store gift cards
hotel/motel or AirBnB
storage units
security deposit
rent/mortgage
utilities
transportation assistance such as Uber/Lyft/Taxi or gasoline

We encourage you to search our Community Resource website for these needs.

Will you be requesting school transportation services for any of the students listed on this form?
Note: MKV transportation does not automatically roll over from the previous school year. It must be requested again if needed and if the student is approved for MKV status again.

After you submit this form, a "thank you" page will appear and it will provide you with the link to the 2025-26 McKinney-Vento Transportation Form. Be sure to complete and submit that form if the situation meets one of the reasons listed above as to why MKV would set up special transportation services.

IMPORTANT INFORMATION REGARDING MCKINNEY-VENTO ...

Determination of homelessness (as defined by MKV) is based on the consideration of the permanence and adequacy of the living situation and is always individually reviewed on a case-by-case basis by the MKV staff.

Any person making a materially false statement regarding residency in a school division may be guilty of a Class 4 Misdemeanor and may be liable to the school division in which the student was enrolled as a result of such false statements for tuition charges, pursuant to the Virginia Code §22.1-5, for the time the student was enrolled in such school division.

The student's MKV status is valid only for the school year in which the student is approved. A student/family must re-apply or contact the PWCS MKV Office to be re-assessed for the next school year's MKV program.The MKV Office begins accepting MKV Eligibility Forms on July 15 of every summer.

To learn more about a MKV student’s rights, visit this website.

MCKINNEY-VENTO HOMELESS EDUCATION SERVICES AGREEMENT

I (person completing this form) certify that all of the information provided on this eligibility application is accurate to the best of my knowledge.
The parent/custodian/caregiver/HUY student understand that …
- Approved student(s) will receive MKV services/transportation through the remainder of the school year even if the student moves into permanent housing.
- It is their responsibility to update the school office with any changes in address or contact information. The parent/custodian/caregiver/HUY student will also need to provide the school with a good mailing address which might not be the address where the student/family is residing due to reasons of confidentiality or risking others housing situation.
- The student(s) has the right to participate in extracurricular school activities; however, the MKV Act does not explicitly require that transportation be provided to/from extracurricular activities. MKV transportation services are only offered according to the school's bell schedule.
- If the student(s) does not maintain regular/on-time attendance, good academic performance and/or exhibit good behavior in school on a regular basis, a Best Interest Determination (BID) meeting might be held to discuss transferring to the school that is zoned for the student's residence, if those concerns would be greatly reduced or eliminated in the local school and if the change would be in the student’s best interest. The parent/custodian/caregiver/HUY student also understands that they would have the right to appeal a decision and the MKV Liaison will supply information if requested.
- That a false claim of homelessness or false residency information could result in the withdrawal of the student from school.

Is there any additional information that you would like to share with the MKV Office Staff?

RESPONSE TO THIS FORM WILL BE SENT VIA EMAIL
(please watch your email inbox along with your email spam/junk boxes)

Signature of Person Completing this Form (which can be parent//custodian/caregiver/HUY student OR Person Representing the Family/Student: *This question is required.

Clear

Signature of

CLICK ON THE "SUBMIT" BUTTON ONCE THE FORM IS COMPLETE TO SEND THE INFORMATION TO THE MKV STAFF FOR REVIEW

PWCS McKinney-Vento Eligibility Form - 2025-26 School Year