MILITARY FAMILY STATUS FORM The State of

MILITARY FAMILY STATUS FORM The State of

BLACKSTONE-MILLVILLE REGIONAL SCHOOL DISTRICT
175 LINCOLN STREET
BLACKSTONE, MASSACHUSETTS 01504
ALLEN W. HIMMELBERGER
SUPERINTENDENT OF SCHOOLS
(508) 883-4400 OPTION #9 (508) 883-9892 FAX LINE
Website: www.bmrsd.net
DAVID L. THOMSON, Ed. D.
ASSISTANT SUPERINTENDENT
MILITARY FAMILY STATUS FORM
The State of Massachusetts has joined an Interstate Compact on Educational Opportunity for
Military Children as part of the Valor Act.
As a result, the State is collecting the following information:
Student’s name:_______________________________________
School: (circle one):
MES
JFK
Is this student a child of a Military Family*?
AFM
YES _______
FWHMS
BMRHS
NO ________
* Eligible for Assistance under the Compact: Students who are children of:
 Active duty members of the uniformed services, National Guard and Reserve on
active duty orders.
 Members or veterans who are medically discharged or retired for one year.
 Members who die on active duty.
Parent/Guardian Signature ________________________________
Date _____________
Please call the main office at the school if you would like this document translated into a language other than English.
Por favor, contate a secretaria central da escola caso deseje que este documento seja traduzido para o português.
Por favor, llame a la oficina central de la escuela si usted desea que este documento sea traducido al español.
‫الرجاء اإلتصال بالمكتب الرئيسي في المدرسة إذا أردتم ترجمة هذه الوثيقة إلى اللغة العربية‬