GREENBUSH 

EDUCATION SERVICE CENTER

MIGRANT SURVEY

Have you moved into the school district within the past 2 years?

 ___ Yes            ___ No

Have you or any member of your immediate family every done any type of agricultural work during the last 3 years?

___ Yes            ___ No

Have you or any member of your immediate family ever been employed in a food processing plant during the last 3 years?

___ Yes            ___ No

Do you or any member of your immediate family speak any other language at home other than English?

 ___ Yes            ___ No

If so what is the language spoken at home? ________________________________________

IF YOU ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS

PLEASE FILL OUT THE INFORMATION BELOW

Parent/Guardian Name: _________________________________________________________

Address: _____________________________________________________________________

Phone Number: _______________________________________________________________

Please return completed form to:

Greenbush Migrant Program

947 W. 47 Hwy.

Girard, KS 66743

Fax# 620-724-7001