Student Residency Questionnaire





Kelton Independent School District Name of School ____________________________________________________________________________ Name of Student: ____________________________________________________________ Sex: ˆ Male Last First Middle ˆ Female /

Birth Date Month

/

Age: _________

Social Security #: ___________________________

/ Day / Year

(or student identification number)

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Is your current address a temporary living arrangement?

_____ Yes

2.

Is this temporary living arrangement due to loss of housing or economic hardship? _____ Yes

_____ No

_____ No

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