AR Migrant Education Program (ARMEP)

Employment Survey

TITLE I, PART C of ESEA
District:
Your child may qualify to receive: free school supplies, free school meals, free books, free high school credits through correspondence, college scholarships, a free year of college at selected sites, limited health services.
Parent Information
Parent Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Physical Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List all children in the household under the age of 22

Have you or anyone in the household worked at least one day in any of the areas listed below during the last three years? Please check ALL that apply.

Rows	Check	Date	Location
Processing Plants (meat, poultry, fruit, dairy, products, vegetables)
Poultry Houses (catching, caring for chickens, turkeys, or picking up eggs)
Caring for Livestock
Nurseries (plants or trees)
Cotton Gin
Farming (planting, fertilizing, harvesting crops, cutting and bailing hay, etc)
Fish Farms or Processing Fish or Seafood
Fruit Harvesting (watermelons, picking berries)
Timber Work (clearing land, skidding logs, planting, thinning or harvesting trees)
Wood Processing (sorting, trimming, splitting logs, cutting lumber ie: pallet,chip, or sawmills)
Other
None of the Above

Parent Signature
For more information, contact: Tiffany Billingsley (901) 830-8146.
Should be Empty:

Employment Survey

Parent Information