"Parent Occupational Survey" - Georgia (United States) (English/Spanish)

Parent Occupational Survey is a legal document that was released by the Georgia Department of Education - a government authority operating within Georgia (United States).

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Download "Parent Occupational Survey" - Georgia (United States) (English/Spanish)

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Distrito Escolar: ______________________
Fecha: _________________
Encuesta Ocupacional para Padres
Favor de completar este formulario para ayudarnos a determinar si su(s) hijo(s) califica(n) para recibir
servicios suplementarios de parte del Programa de Título I, Parte C
Nombre del/los Estudiante(s)
Nombre de la Escuela
Grado
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
1. ¿Alguien en su casa se ha mudado para trabajar en otra ciudad, condado, o estado, en los últimos tres (3) años?
No
2. ¿Alguien en su casa trabaja o ha trabajado en una de las siguientes ocupaciones de forma permanente o temporaria en los últimos
tres años?
No
Si la respuesta es “si”, marque todo trabajo que aplique:
 1. Sembrando/Cosechando vegetales (tomates, calabazas, cebollas, etc.) o frutas (uvas, fresas, arándanos, etc.)
 2. Sembrando, cortando, procesando árboles, o juntando paja de pino (pine straw)
 3. Procesando/Empacando productos agrícolas
 4. Trabajo en lechería, polleras o ganadería
 5. Empacando/Procesando carnes (res, pollo, o mariscos)
 6. Trabajos relacionados con la pesca (pesca comercial, o criadero de pescados)
 7. Otra actividad. Por favor especifique en cuál: _________________________________________________________
Nombre de los padres o guardianes legales: ______________________________________________________________
Dirección donde vive: ________________________________________________________________________________
Ciudad: _______________ Estado: __________ Código Postal: _______________ Teléfono: ______________________
¡Muchas Gracias! Por favor regrese éste formulario a la escuela
Please maintain original copy in your files.
MEP funded school/district: Please give this form to the migrant liaison or migrant contact for your school/district.
Non-MEP funded (consortium) school/districts: When at least one “yes” and one or more of the boxes from 1 to 7 is/are checked, districts should fax occupational
surveys to the Regional Migrant Education Program Office serving your district. For additional questions regarding this form, please call the MEP office serving your
district:
GaDOE Region 1 MEP, 201 West Lee Street, Brooklet, GA 30415
GaDOE Region 2 MEP, 221 N. Robinson Street, Lenox, GA 31637
Toll Free (800) 621-5217 Fax (912) 842-5440
Toll Free (866) 505-3182 Fax (229) 546-3251
Family Contacted/Attempt Date: __________
Sent to Regional Office on: ____________
1854 Twin Towers East • 205 Jesse Hill Jr. Drive • Atlanta, GA 30334 • www.gadoe.org
Distrito Escolar: ______________________
Fecha: _________________
Encuesta Ocupacional para Padres
Favor de completar este formulario para ayudarnos a determinar si su(s) hijo(s) califica(n) para recibir
servicios suplementarios de parte del Programa de Título I, Parte C
Nombre del/los Estudiante(s)
Nombre de la Escuela
Grado
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
1. ¿Alguien en su casa se ha mudado para trabajar en otra ciudad, condado, o estado, en los últimos tres (3) años?
No
2. ¿Alguien en su casa trabaja o ha trabajado en una de las siguientes ocupaciones de forma permanente o temporaria en los últimos
tres años?
No
Si la respuesta es “si”, marque todo trabajo que aplique:
 1. Sembrando/Cosechando vegetales (tomates, calabazas, cebollas, etc.) o frutas (uvas, fresas, arándanos, etc.)
 2. Sembrando, cortando, procesando árboles, o juntando paja de pino (pine straw)
 3. Procesando/Empacando productos agrícolas
 4. Trabajo en lechería, polleras o ganadería
 5. Empacando/Procesando carnes (res, pollo, o mariscos)
 6. Trabajos relacionados con la pesca (pesca comercial, o criadero de pescados)
 7. Otra actividad. Por favor especifique en cuál: _________________________________________________________
Nombre de los padres o guardianes legales: ______________________________________________________________
Dirección donde vive: ________________________________________________________________________________
Ciudad: _______________ Estado: __________ Código Postal: _______________ Teléfono: ______________________
¡Muchas Gracias! Por favor regrese éste formulario a la escuela
Please maintain original copy in your files.
MEP funded school/district: Please give this form to the migrant liaison or migrant contact for your school/district.
Non-MEP funded (consortium) school/districts: When at least one “yes” and one or more of the boxes from 1 to 7 is/are checked, districts should fax occupational
surveys to the Regional Migrant Education Program Office serving your district. For additional questions regarding this form, please call the MEP office serving your
district:
GaDOE Region 1 MEP, 201 West Lee Street, Brooklet, GA 30415
GaDOE Region 2 MEP, 221 N. Robinson Street, Lenox, GA 31637
Toll Free (800) 621-5217 Fax (912) 842-5440
Toll Free (866) 505-3182 Fax (229) 546-3251
Family Contacted/Attempt Date: __________
Sent to Regional Office on: ____________
1854 Twin Towers East • 205 Jesse Hill Jr. Drive • Atlanta, GA 30334 • www.gadoe.org
_________________
School District: _____________________
Date:
Parent Occupational Survey
Please complete this form to determine if your child(ren) qualify to receive supplemental services under
Title I, Part C
Name of Student(s)
Name of School
Grade
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
____________________________________
_____________________________
__________________
1. Has anyone in your household moved in order to work in another city, county, or state, in the last three (3) years?
Yes
No
2. Has anyone in your household been involved in one of the following occupations, either full or part-time or temporarily during the
last three (3) years?
Yes
No
If you answer “yes”, check all that applies:
 1) Planting/Picking vegetables (tomatoes, squash, onions, etc.) or fruits (grapes, strawberries, blueberries, etc.)
 2) Planting, growing, cutting, processing trees (pulpwood), or raking pine straw
 3) Processing/Packing agricultural products
 4) Dairy/Poultry/Livestock
 5) Packing/Processing meats (beef, poultry, or seafood)
 6) Commercial fishing or fish farms
 7) Other (Please specify occupation): ___________________________________________________________
Names of Parent(s) or Legal Guardian(s) ______________________________________________________________
Current Address: ____________________________________________________________________________________
City: ________________________State: _____________ Zip Code: _____________Phone: __________________________
Thank You! Please return this form to the school
Please maintain original copy in your files.
MEP funded school/district: Please give this form to the migrant liaison or migrant contact for your school/district.
Non-MEP funded (consortium) school/districts: When at least one “yes” and one or more of the boxes from 1 to 7 is/are checked, districts should fax occupational
surveys to the Regional Migrant Education Program Office serving your district. For additional questions regarding this form, please call the MEP office serving your
district:
GaDOE Region 1 MEP, 201 West Lee Street, Brooklet, GA 30415
GaDOE Region 2 MEP, 221 N. Robinson Street, Lenox, GA 31637
Toll Free (800) 621-5217 Fax (912) 842-5440
Toll Free (866) 505-3182 Fax (229) 546-3251
Family Contacted/Attempt Date: __________
Sent to Regional Office on: __________
1854 Twin Towers East • 205 Jesse Hill Jr. Drive • Atlanta, GA 30334 •
www.gadoe.org
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