AEL-Self-Attestation-Form Name* First Middle Last DATE OF BIRTH* MM DD YYYY Social Security Number*LOCAL PHONE NUMBEREmail* Purpose: To determine whether an individual who is 17 or 18 years of age and who cannot obtain a parent’s or guardian’s permission meets the criteria for receiving a qualified exemption under TEC 25.086Form 1: To determine whether an AEL services candidate is already attending secondary schoolAre you attending school?YesNoIf YES, name of schoolIf NO, what is the last date that you attended school? Date Format: MM slash DD slash YYYY Are you enrolled in public school for next semester?YESNoI,verify that the information I have provided is true and correct.Signature*Date* Date Format: MM slash DD slash YYYY Form 2: To determine whether an AEL services candidate is living with a parent:Do you live in a home that your parent owns or rents? (Note: If yes, parental permission is required)YesNoWhere do you usually sleep at night? (street address, apartment number, city, Zip code) Address Apartment # City ZIP Code How long have you been at that address?Year(s)Month(s)Day(s)Do you pay or receive bills in your name?YesNoWhat bills do you pay or receive? Please list: To what address are the bills delivered? Address City State / Province / Region ZIP / Postal Code What is your parents or guardians address, if different from where you sleep at night? Address City State / Province / Region ZIP / Postal Code When was the last time you slept at your parent’s or guardian’s address?Form 3: To determine whether an AEL services candidate is homeless as defined in 42 USC §11302Do you live in a place that has no windows, doors, running water, heat, or electricity?YesNoAre you living in a place that is overcrowded?YesNoAre you staying with a friend or relative because of a loss of housing or economic hardship, or for a similar reason?YesNo(Examples include eviction, foreclosure, fire, flood, divorce, domestic violence, the loss of a job, being told to leave by your parent, and running away from home.)Are you living in a shelter?YesNo(Examples include a family shelter, a domestic violence shelter, a shelter for children or youth, and housing funded by the Federal Emergency Management Agency.)Are you living in an unsheltered location?YesNo (Examples include living in a tent, in a vehicle, in an abandoned building, at a campground, in a park, and in a bus or train station.)Are you living in a hotel or motel because of a loss of housing or economic hardship?YesNo(Examples include eviction, foreclosure, flood, fire, hurricane, and lack of money to pay deposits for a permanent home.)Are you living in transitional housing?YesNo (that is, housing that is available as part of a program, is offered for a specific length of time only, and is partly or completely paid for by a church, a nonprofit organization, a governmental agency, or another type of organization)NameThis field is for validation purposes and should be left unchanged.