• IDOE: Supporting Student Success  
    The Migrant Education Program (MEP) provides supplemental education and support services to eligible
    children through national funding. The purpose of the program is to ensure that all migrant students reach
    the academic standards and graduate with a high school diploma (or complete a GED).
    Thank you for answering the following questions. If your child is eligible for the Migrant Education
    Program, they may receive additional educational support. This information is strictly confidential.
    Student’s Name: ________________________________Parent’s Name: ______________________________________
    Address: _________________________________________City:______________________ Telephone: (___) _________
    Date:_____________________________________________ Parent Signature:__________________________________
    1. How long have you lived in this city/school district? _____________________________
    2. Within the last 3 years, has your child(ren) moved from one school district to another within the
    United States, with a parent, relative or guardian so that person could look for seasonal or
    temporary work in agriculture? YES ___ NO _____ If you answered NO, please stop.
    If you answered YES, please continue.
    3. When was the last time you or anyone in your household has moved to look for, or work in an
    agricultural activity within the United States? Month________________ Year_________________
    4. Please check any of the agricultural activities listed below that you have looked for or worked in:
    _____ Plant or harvest vegetables or fruits  _____ Canning vegetables or fruits
    _____ Detassel corn _____ Sod farm
    _____ Tobacco farm_____ Planting, pruning or cutting trees
    _____ Poultry and/or egg farm_____ Dairy farm
    _____ Duck, turkey, chicken, pork or beef processing plant_____ Flora culture/gladiola farm
    _____ Aquaculture/fish hatcheries     _____ Green house or plant nursery 

    Please list the names of all of the children in the household under 22 years of age.
         Child’s Name Date of Birth                                   (D.O.B.)
    Revised 2/26/2014