HCS Primary Telephone: 256-428-6800
After-Hours Emergency Contact: 256-428-8355
Image Name (last, first) Sort descending Job Title Email Phone Department
Deandrea Williams, Deandrea Work Based Learning Coordinator Contact 256-384-5202 Secondary Programs
Jeffrey Wilson, Jeffrey Director of Operations Contact 256-428-8310 Operations
Nancy Wolfe, Nancy District College and Career Counselor serving Columbia and New Century Technology High Schools Contact 256-348-8443 School Counseling Services
Leanetta Wright, Leanetta Finance Director Contact 256-428-6875 Finance
Young, Chris Collaborative Services Coordinator Contact 256-963-9792 Special Education
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Parent/Guardian or Unaccompanied Youth Information

Please enter the name of the parent/guardian completing this form out.
Please enter a valid phone number for the person submitting this form.
Please provide the name of the shelter, hotel address, or location of where you slept last night.
Preferred Communication
Please choose the preferred methods of communication. (Check all that apply.)

 

Student Information

Please select the school of the student in need of assistance.
Student IEP?
Please indicate whether the student has an IEP.
Student Transportation
Does the student have reliable transportation?
Second Student
Please indicate whether you have another student living in the household.

Student 2 Information

Please select the school of the student in need of assistance.
Student 2 IEP?
Please indicate whether the student has an IEP.
Third Student
Please indicate whether you have another student living in the household.

Student 3 Information

Please select the school of the student in need of assistance.
Student 3 IEP?
Please indicate whether the student has an IEP.
Fourth Student
Please indicate whether you have another student living in the household.

Student 4 Information

Please select the school of the student in need of assistance.
Student 4 IEP?
Please indicate whether the student has an IEP.

 

Family Situation

Family Needs
Is your family in need of any of the above? (Please check all that apply.)
Current Living Situation
Where is the student or students living right now? (Select only one.)
Reason(s)
Please indicate the primary reasons for homelessness. (Please check all that apply.)
Please explain the circumstances that lead to your homelessness.

 

Declarations

Please enter the last date of permanent residency.
Declaration of Understanding
Please select yes or no to affirm the above statement.
Guardian or Student Declaration
Please select yes or no to affirm the above statement.
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TYPE OF ORGANIZATION
MINORITY OWNED BUSINESS

Names of Officers, Members or Owners of Concern, Partnership, Etc.


Names of Officers, Members or Owners of Concern, Partnership, Etc.

Person of Concern 1


Persons to Contact on Matters Concerning Bids and Contracts

Person to Contact 1

Person to Contact 2

COMMODITY LIST

Check all that apply.
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