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Form Ed-5438 - Migrant Education Program Occupational Survey - Tennessee Department Of Education

Tennessee Department of Education (TDOE)

Title I, Part C of the Elementary and Secondary Education Act (ESEA)

Migrant Education Program

Occupational Survey

Student Information: ______________________________________________________________________________

Last Name

First Name

Gender

Race

District ______________________School: _____________________________________Grade_______ Year _______

Migrant students may be eligible for additional services and assistance. Please answer the following questions and return the

survey to the school so that we can determine if your child qualifies for migrant services.

1. Did you or someone in your family come to Tennessee looking for temporary or seasonal work in agriculture, fishing,

dairy, or in any plant processing foods (examples: working with tobacco, tomatoes, cotton, strawberries, nurseries,

trees, pork, chickens, vegetables, etc)?

YES _____

NO _____ If yes, please mark which member of the family does or did this kind of work:

Mother ____ Father ____ Children ____ Other _____

2. Do you or someone in your family currently work in agriculture fishing, dairy, or in any plant processing foods

(examples: working with tobacco, tomatoes, cotton, strawberries, nurseries, trees, pork, chicken, vegetables, etc).

YES _____

NO _____ If yes, please mark which member of the family does or did this kind of work:

Mother ____ Father ____ Children ____ Other _____

3. If your current job is not temporary work in agriculture or fishing, did you or someone in your family work in a

temporary or seasonal agriculture of fishing in the last 3 years?

YES ________

NO_____

If yes, where? _________________________________

_____________

______________________

City

State

Country

If you answered “yes” to any of the questions above, please answer questions 4, 5 and 6.

4. How long have you been in this county? _______________________________________

months

years

5. What is your current address? _________________________________________________________________

6. What is your current telephone number? ________________________________________________________

NOTE TO THE LEA: Please return only surveys with one or more “yes” responses to Jessica Castaneda 4660 Hills Creek

Road, McMinnville TN 37110 or fax to 931-668-2611. Call 931-668-4139 if you have questions.

February 2015

TN form #ED-5438

Form Ed-5438 - Migrant Education Program Occupational Survey - Tennessee Department Of Education