Homeless Youth Verification Form

Address*

Purpose:  This form is provided to determine if a student is considered a homeless youth. If declared homeless, the student will retain priority registration for a period of up to six years from the date of admission to the postsecondary educational institution.

Homeless Youth Definition: A student 23 years of age or younger, who has been verified at any time during the 24 months immediately preceding the receipt of his or her application for admission by a postsecondary educational institution that is a qualifying institution pursuant to Section 69432.7, as a homeless child or youth, as defined in subsection (2) of Section 725 of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 1143a(2)0:

“The term homeless children and youths- refers to individuals who lack a fixed, regular, and adequate nighttime residence (within the meaning of section 103(1)(1)), including:

(i) children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; are abandoned in hospitals; or are awaiting foster care placement;

(ii) children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings (within the meaning of section 103(a)(2)(C));

(iii) children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and

(iv) migratory children (as such term is defined in section 1309 of the Elementary and Secondary Education Act of 1965) who qualify as homeless for the purposes of this subtitle because the children are living in circumstances described in clauses (i) through (iii).

Determination of Homeless Youth Status: Homeless Assistance Act (42 U.S.C. Sec. 11434a(2)), by at least one of the following:(i) A homeless services provider, as that term is defined in paragraph (3) of subdivision (d) of Section 103577 of the Health and SafetyCode.(ii) The director of a federal TRIO program or Gaining Early Awareness and Readiness for Undergraduate Programs program, or a designee of that director.(iii) A financial aid administrator for an institution of higher education. A student may turn in a statement if they are unable to provide any paper work to verify their homeless status.


TO BE COMPLETED BY THE STUDENT

In which of the following situations did you reside during homelessness:*
Please check all that may have resulted in your lack of adequate housing:*
In which of the following situations do you currently reside:*
Please Check scenarios that describes your current financial situation:*
Attach one of the following documents as stated above for the determination of homelessness. *
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By checking here, I declare that: 1. All of the information in this application pertains to me. 2. Under penalty of perjury, the statements and information submitted in this online Homeless Youth Verification form are true and correct.*

For Staff Use Only

Determination of Homeless Youth:*
Under 24 years of age*
First Name/ Last Name/ Title
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