Bentworth School District

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Welcome to the Bentworth School District!!                  Title 1 Distinguished Elementary School               Ranked as a U.S. News Best Middle School              Identified as a Schools To Watch Middle School  (3x)            National Blue Ribbon High School                       Ranked as a U.S. News Best High School                Bentworth High School Global Educational Excellence Award            


Editing previous response:

Please fix the highlighted areas below before submitting.


Bentworth School District

Student Residency Questionnaire

Dear Parent or Guardian,

Your responses to these questions will help the staff determine what residency documents are necessary for the enrollment of your child(ren).  Thank you for your cooperation.

Answer Required

In what type of setting is the student now living? 

Please check one below in either section "A" or Section "B":

Section A

Section B

▢ In an emergency or transitional shelter

▢ Sharing the housing of other persons due to loss of housing, economic hardship, or similar reason

▢ In a motel, hotel, campsite, or car due to a lack of alternative adequate accommodations

▢ In a car, park, public spaces, abandoned building, substandard housing, bus or train stations, or similar settings

▢ Other places not designed for, or ordinarily used as, a regular sleeping accommodations for human beings

▢ Living without running water, heat, or electric service


CONTINUE to the next question if you meet the criteria for any box in SECTION A

 ▢ None of the choices in Section A apply.

If you checked this section, you DO NOT need to complete the remainder of this form. Submit the form to school personnel now.

The student lives with:*
Check ALL that apply
Answer Required
Does the student have an IEP, GIEP, or Chapter 15/504 Agreement?*
Answer Required