Admin

Migrant Worker Form

IDOE

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).

WORK SURVEY

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.)

1.
2.
3.
4.
5.