COE Instructions and Template

OMB Control No.: 1810-0662

Exp. 11/30/2014

Education of Migratory Children under Title I, Part C of the

Elementary and Secondary Education Act of 1965

NATIONAL

CERTIFICATE OF ELIGIBILITY (COE)

INSTRUCTIONS

U.S. Department of Education

Office of Elementary and Secondary Education

The National

Certificate of Eligibility

Purpose

The State Education Agency (SEA) is required to document every migrant child’s eligibility for the Migrant Education Program on the national Certificate of Eligibility (COE) created by the U.S. Department of Education (ED). The COE serves as the official record of the State’s eligibility determination for each individual child.

Table of Contents

Overview 1

General instructions 2

Completing the Required Data Elements of the COE (part I) 3

Family Data. 3

Child Data. 4

Completing the Required Data Sections of the COE (part II) 5

Qualifying Move & Work Section. 5

Comments Section 12

Parent/Guardian/Spouse/Worker Signature Section. 14

Eligibility Certification Section. 15

Attachments 16

Overview

The U.S. Department of Education (ED) has created a standard national COE that all states are required to use. The national COE is comprised of three parts:

(1) required data elements, which States can organize according to State preference and need;

(2) required data sections, which States can place according to State preference and need, but that must be maintained in whole and unaltered; and

(3) State required/requested information, where space is available, that States can use to collect other data.

NOTE: States must maintain any additional documentation the SEA requires to confirm that each child found eligible for the program meets all of the eligibility definitions. State responsibilities for documenting the eligibility of migratory children are found in 34 CFR 200.89(c).

Attached are two documents. The first summarizes the required data elements and required data sections in a one-page format. The second is a template that demonstrates how the required data elements and required data sections might be arranged on the COE. Note that this template does not necessarily include elements that are required to be collected for other OME or ED data collections. States can either use the template as-is, or they can modify it, within the parameters explained in (1), (2) and (3) above, to collect this or any other State required/requested information.

General instructions

• A COE must be completed every time a child makes a new qualifying move.

• All attempts should be made to complete all data elements and sections of the COE. In cases where a response may not be required or does not apply, flexibility has been built into the instructions. In these cases, the recruiter must write a dash (-) or “N/A” in the appropriate blank. All other information must be provided.

• With the exception of the “Qualifying Move and Work Section,” if the instructions ask for additional information in the Comments section and the State has required this information as a State data element, the recruiter does not need to provide the information again in the Comments section. For example, the instructions prompt the recruiter to record the first and last names of the child’s legal parents in the Comments section if different from the current parents. However, if the State includes data elements for legal parent information, the recruiter would not have to repeat this information in the Comments section.

• If the recruiter completes a COE for a family, the recruiter must fill out a separate COE for any child who has a different qualifying arrival date (QAD) or for any child who has different eligibility criteria than the rest of the children in the family, such as an out of school youth (OSY) who may have moved on his or her own. In general, the QAD is the date that both the child and worker completed the move for the worker to find qualifying work. There are special cases that are described in the instructions for the section titled “Qualifying Move and Work Section.”

• The recruiter must not include any child who:

  • (1) was born after the qualifying move;

  • (2) is not eligible to receive a free public school education [e.g., has graduated from a high school or obtained a General Educational Development (GED) certificate]; or

  • (3) did not make the qualifying move described on the COE.

• If more than one COE is necessary, the recruiter must complete all sections on each form.

Completing the Required Data Elements of the COE (part I)

Family Data. In this section of the COE, the recruiter will record the name and address of the child’s male and/or female parent or parents.

• Male Parent/Guardian [Last Name(s), First Name]. Record the name of the male (if any) currently responsible for the child(ren). Record this individual’s legal last name (or names) and legal first name. If the male parent has two last names or a hyphenated last name, record the male parent’s last name(s) as it legally exists. The term “parent” on this form and in other sections of these instructions includes a legal guardian or other person who is standing in the place of the parent or in loco parentis (such as a grandparent, spouse, or stepparent with whom the child lives who is responsible for the welfare of the child). If the child has more than one male parent or if the child’s legal parent is different from the current parent, provide the name of the child’s legal male parent in the Comments section. If there is no parent information disclosed, write a dash (-) or “N/A.” If the “child” is the worker and a male, write the child’s name for this data element.

• Female Parent/Guardian [Last Name(s), First Name]. Record the name of the female (if any) currently responsible for the child(ren). Record this individual’s legal last name (or names) and legal first name. If the female parent has two last names or a hyphenated last name, record the female parent’s last name(s) as it legally exists. The term “parent” on this form and in other sections of these instructions includes a legal guardian or other person who is standing in the place of the parent or in loco parentis (such as a grandparent, spouse, or stepparent with whom the child lives who is responsible for the welfare of the child). If the child has more than one female parent or if the child’s legal parent is different from the current parent, provide the name of the child’s legal female parent in the Comments section. If there is no parent information disclosed, write a dash (-) or “N/A.” If the “child” is the worker and a female, write the child’s name for this data element.

• Current Address. Record the physical address, including the complete name of the street or road where the child(ren) currently resides. In cases where a formal physical address is not available, include as much other identifying information as possible (e.g., trailer number, rural route, migrant camp, landmark). If the physical address is different from the mailing address, provide the mailing address in the Comments section of the COE.

• City. Record the name of the city or town where the child(ren) currently resides.

• State. Record the postal abbreviation used by the U.S. Postal Service for the State where the child(ren) currently resides.

• Zip. Record the five or nine-digit zip code where the child(ren) currently resides. The U.S. Postal Service has an online zip code directory service at http://zip4.usps.com/zip4/welcome.jsp.

• Telephone. Record the telephone number, including area code, of the family. If no telephone number is available, write a dash (-) or “N/A.”

Child Data. Child/school data includes the name, sex, birth date, etc. of each child. A recruiter should include all children with the same family and eligibility data on the same COE. Any child who has different (1) current family [see “Family Data” above for additional definition] or (2) eligibility data—including a different QAD—must be documented on a separate COE.

• Residency Date. If the “Residency Date” is different from the QAD, record the date (MM/DD/YY) that the child(ren) entered the present school district. Use the two-digit number that refers to the month and day, and the last two digits of the year. For example, May 20, 2008, would be written as 05/20/08. If the child(ren) qualified for the MEP on a move prior to the move to the present school district, the residency date will be later than the QAD. If the child(ren) moved prior to the worker’s move, the residency date would precede the QAD. If the “Residency Date” is the same as the QAD, write a dash (-) or “N/A.” Note, although it is possible to record a residency date that precedes the QAD, a COE cannot be filled out and a child cannot be enrolled in the MEP until after the child and worker make the qualifying move.

• Last name 1. Record the legal last name of each eligible child in the family. If the child has a multiple or hyphenated last name (e.g., Ramírez-García), record the first part of the name (i.e., Ramírez).

• Last name 2. If the child has a multiple or hyphenated last name (e.g., Ramírez-García), record the second part of the name (i.e., García). If the child does not have a multiple or hyphenated name, write a dash (-) or “N/A.”

• Suffix. Where applicable, record the child’s generation in the family (e.g., Jr., Sr., III, 3^rd). Otherwise, write a dash (-) or “N/A.”

• First name. Record the legal first name of each eligible child in the family. This is the name given to the child at birth, baptism, or during another naming ceremony, or through a legal name change. Do not record nicknames or shortened names (e.g., Ale or Alex for Alejandra).

• Middle name. Record the legal middle name of each eligible child in the family. This is the secondary name given to the child at birth, baptism, or during another naming ceremony, or through a legal name change. Do not record nicknames or shortened names (e.g., Ale or Alex for Alejandra). If the child does not have a middle name, write a dash (-) or “N/A.”

• Sex. Record the child’s sex: “M” for male or “F” for female.

• Birth Date. Record the month, day and year the child was born. Use the two-digit number that refers to the month and day, and the last two digits of the year. For example, September 20, 2003, would be written as 09/20/03.

• Multiple Birth Flag (MB). Record “Y” for “yes” if the child is a twin, triplet, etc. Write a dash (-) or “N/A” for not applicable (i.e., the child is not a twin, triplet, etc.).

• Birth Date Verification Code (Code). Record the last two numbers that correspond to the evidence used to confirm each child’s birth date (see the codes and corresponding evidence listed below).

A birth certificate is the best evidence of the child’s birth date, if available. If a birth certificate is not available, the interviewer may use another document to confirm the child’s birth date, including any of those listed below.

• 1003 – baptismal or church certificate;

• 1004 – birth certificate;

• 1005 – entry in family Bible;

• 1006 – hospital certificate;

• 1007 – parent’s affidavit;

• 1008 – passport;

• 1009 – physician’s certificate;

• 1010 – previously verified school records;

• 1011 – State-issued ID;

• 1012 – driver’s license;

• 1013 – immigration document;

• 2382 – life insurance policy; or

• 9999 – other.

If written evidence is not available, the interviewer may rely on a parent’s or emancipated youth’s verbal statement. In such cases, the interviewer should record “07” – the number that corresponds to “parent’s affidavit.”

Completing the Required Data Sections of the COE (part II)

Qualifying Move & Work Section. In this section, record the qualifying move and qualifying work information which the State believes documents the child’s eligibility for the program. Note that exceptions apply for moves within States comprised of a single school district and school districts of more than 15,000 square miles. See #1 (immediately below) for how to document these exceptions.

1. The child(ren) listed on this form moved from a residence in _________ (School District/City/State/Country) to a residence in __________ (School District/City/State).

• from a residence in _________ (School District/City/State/Country). This location is the last place of residency before the child(ren) and the parent, spouse or guardian moved due to economic necessity in order to obtain qualifying work. Note that the child(ren) might have made subsequent non-qualifying moves.

• to a residence in __________ (School District/City/State). This location is the place of residency where the child(ren) and the parent, spouse or guardian moved due to economic necessity in order to obtain qualifying work. A qualifying move can never be made to a country outside of the United States. As mentioned previously, the child(ren) might have made subsequent non-qualifying moves.

Following are several “qualifying move” scenarios. Identify which scenario applies to the specific eligibility situation and record the necessary information.

• If the child(ren) moved from a residence in one school district to a residence in another school district within the same U.S. city –

  • from a residence in _________ (School District/City/State/Country) - Record the full legally or commonly used name of the school district where the child(ren) listed resided immediately prior to the qualifying move. Also record the name of the city from which the child(ren) listed moved.

  • to a residence in __________ (School District/City/State) - Record the full legally or commonly used name of the school district where the child(ren) listed resided immediately following the qualifying move. Also record the name of the city from which the child(ren) listed moved.

• If the child(ren) moved from a residence in one school district to a residence in another school district within the same U.S. State (and these school districts are not within the same U.S. city) –

  • from a residence in _________ (School District/City/State/Country) - Record the name of the city where the child(ren) listed resided immediately prior to the qualifying move.

  • to a residence in __________ (School District/City/State) - Record the name of the city where the child(ren) listed resided immediately following the qualifying move.

• If the child(ren) moved from a residence in one U.S. State to a residence in another U.S. State –

  • from a residence in _________ (School District/City/State/Country) - Record the name of the city and State where the child(ren) listed resided immediately prior to the qualifying move.

  • to a residence in __________ (School District/City/State) - Record the name of the city and State where the child(ren) listed resided immediately following the qualifying move.

• If the child(ren) moved from a residence in a country other than the U.S. to a residence in the U.S. –

  • from a residence in _________ (School District/City/State/Country) - Record the name of the State (within the other country) if available and the name of the country where the child(ren) listed resided immediately prior to the qualifying move.

  • to a residence in __________ (School District/City/State) - Record the name of the city and State in the U.S. where the child(ren) listed resided immediately following the qualifying move.

• Exception. If the child(ren) migrated a distance of 20 miles or more to a temporary residence in a school district of more than 15,000 square miles (NOTE: this exception only applies to the children of migratory fishers or children who are migratory fishers) –

  • from a residence in _________ (School District/City/State/Country) - Record the name of the city where the child(ren) listed resided immediately prior to the qualifying move. Also record the name of the school district within which this city is located. (NOTE: school district name is requested in order to identify this move as one that meets the 20 miles criterion).

  • to a residence in __________ (School District/City/State) - Record the name of the city where the child(ren) listed resided immediately following the qualifying move. Also record the name of the school district within which this city is located. (NOTE: school district name is requested in order to identify this move as one that meets the 20 miles criterion).

• Exception. If the child(ren) moved from a residence in one administrative area to a residence in another administrative area within a U.S. State that is comprised of a single school district –

  • from a residence in _________ (School District/City/State/Country) - Record the full legally or commonly used name of the administrative area where the child(ren) listed resided immediately prior to the qualifying move. Also record the name of the city from which the child(ren) listed moved.

  • to a residence in __________ (School District/City/State) - Record the full legally or commonly used name of the administrative area where the child(ren) listed resided immediately following the qualifying move. Also record the name of the city from which the child(ren) listed moved.

Provide as much of this information in these blanks as available. At a minimum (with the exception of States comprised of single school districts or school districts of more than 15,000 square miles), the State must be able to document that the child moved across school district lines and changed residences in the process. In the case of States comprised of a single school district, the State must be able to document that the child moved from one administrative area to another and changed residences in the process. In the case of school districts of more than 15,000 square miles, the State must be able to document that the child migrated a distance of 20 miles or more and changed residences in the process.

If the child and parent moved from different previous residences, record the child’s prior residence in response to #1 and record the parent’s residence in the Comments section. In order for the child to be eligible, both the child and the parent must have moved across school district lines and changed residences in the process.

For more information on documenting the move from one school district to another, see the chart below.

Type of move The child(ren) moved…	The child’s residence immediately prior to the qualifying move The child(ren) moved from a residence in ________ (School District/City/State/Country)	The child’s residence immediately following the qualifying move The child(ren) moved to a residence in __________ (School District/City/State)
…from one school district to another within the same U.S. city	School District, City	School District, City
…from one school district to another within the same U.S. State	City	City
…from one U.S. State to another U.S. State	City, State	City, State
…from a country other than the U.S. to the U.S.	State, Country	City, State
…20 miles or more within a school district of more than 15,000 square miles (exception)	School District, City	School District, City
…From one administrative area to another within a U.S. State comprised of a single school district (exception)	Administrative Area, City	Administrative Area, City

2. The child(ren) moved (complete both a. and b.):

a.  on own as a worker, OR  with the worker, OR  to join or precede the worker. [Mark only one box]

• Mark the box “on own as a worker” if the child himself or herself moved in order to obtain qualifying work. Only complete the worker’s name in 2b.

• Mark the box “with the worker” if the child(ren) moved with a parent, spouse or guardian in order for the worker to obtain qualifying work.

• Mark the box “to join or precede the worker” if the child(ren) moved either before or after the date the parent, spouse, or guardian moved in order to obtain qualifying work. If this box is marked, also complete “i” under 2b.

b. The worker, ______________ (First and Last Name of Worker), (Continued below)

• Record the first and last name of the individual who sought or obtained the qualifying work (i.e., parent, spouse, guardian, or child – if on own as a worker).

(Continued from above) …is the child or the child’s  parent  spouse  guardian. [Mark only one box]

• Mark the box that indicates the child’s relationship to the worker (i.e., parent, spouse or guardian). Do not select one of these boxes if “on own as a worker” is checked in 2a.

1. (Complete if “to join or precede” is checked in 2a.) The worker moved on______ (MM/DD/YY). The child(ren) moved on _____ (MM/DD/YY). (provide comment)

• Record the date the worker moved in order to obtain qualifying work. Also record the date the child(ren) moved in order for the parent, spouse, or guardian to obtain qualifying work. Also record the reason for the different moves in the Comments section.

3. The Qualifying Arrival Date was ­­­___________ (MM/DD/YY). Record the QAD, using the two-digit numbers that refer to the month and day, and the last two digits of the year. For example, May 20, 2008, would be written as 05/20/08.

In general, the QAD is the date that both the child and worker completed the move. The child must have moved on his or her own, or with or to join a parent, guardian or spouse to enable the worker (i.e., child, parent, guardian or spouse) to obtain qualifying work. As referenced in 2a, the child and worker will not always move together, in which case the QAD would be the date the child joins the worker who has already moved, or the date when the worker joins the child who has already moved. The QAD is the date that the child’s eligibility for the MEP begins. The QAD is not affected by subsequent non-qualifying moves. For more information on determining the QAD, see the chart below.

Type of Qualifying Move The child. . .	Qualifying Arrival Date (QAD)--Eligibility Begins The QAD is. . .
. . .moved with the worker.	. . .the date the child and worker both arrive in the district where the worker will look for qualifying work.
. . .moved before the worker moved.	. . .the date the worker arrives in the district to look for qualifying work.
. . .moved to join the worker after the worker moves.	. . .the date the child arrives to join the worker.

4. The worker moved due to economic necessity in order to obtain: [Mark only one of the following boxes: either a, b, or c.]

a. qualifying work, and obtained qualifying work, OR

• Mark this box if the child, parent, spouse, or guardian moved due to economic necessity in order to obtain temporary or seasonal employment in agricultural or fishing work, and obtained that work.

b.  any work, and obtained qualifying work soon after the move, OR

• Mark this box if the child, parent, spouse or guardian, moved due to economic necessity in order to obtain any work, and soon after the move obtained temporary or seasonal employment in agricultural or fishing work.

c.  qualifying work specifically, but did not obtain the work. If the worker did not obtain the qualifying work: [NOTE: Also complete box “i,” box “ii” or both.]

• Mark this box if the child, parent, spouse or guardian moved due to economic necessity to obtain temporary or seasonal employment in agricultural or fishing work, but did not obtain that work. If this box is marked, also mark box i, box ii, or both.

i.  The worker has a prior history of moves to obtain qualifying work (provide comment), OR

• Mark this box to indicate that the worker has a prior history of moving to obtain temporary or seasonal employment in agricultural or fishing work. Explain this history in the Comments section. For example, the recruiter could write, “qualifying worker moved from Brownsville, Texas, to Decatur, Michigan, to plant tomatoes in May of 2007.” The recruiter could also check the MSIX database, or other local database, to see if it contains a history of prior moves to obtain qualifying work and attach the print-out to the COE.

2.  There is other credible evidence that the worker actively sought qualifying work soon after the move (provide comment).

• Mark this box to indicate that there is other credible evidence that demonstrates that the worker actively sought qualifying agricultural or fishing work soon after the move, but the work was not available for reasons beyond the worker’s control. For example, a local farmer or grower confirmed that the worker applied for qualifying work but none was available; newspaper clippings document that work was not available because of a recent drought, flood, hail storm, or other disaster in the area. Explain this evidence in the Comments section and attach supporting documentation where available.

4. The qualifying work*, ­­­­­­­­­­­­­­­­_____________ (describe agricultural or fishing work),(Continued below)

• Describe agricultural or fishing work. When describing the specific agricultural or fishing work, the recruiter should use an action verb (e.g., “picking”) and a noun (e.g., “strawberries”). In other words, the recruiter should describe the worker’s action (e.g., “picking”) and the crop, livestock, or seafood (e.g., “strawberries”). For example: picking strawberries; thinning sugar beets; pruning grapes; detasseling corn; catching chickens; planting oysters; walking (weeding) soybeans; and harvesting crabs.

(Continued from above)…was (make a selection in both a. and b.):

1.  seasonal OR  temporary employment, (Continued below)

• Mark the box for “seasonal employment” if the employment occurs only during a certain period of the year because of the cycles of nature and that, by its nature, may not be continuous or carried on throughout the year. (Section 200.81(j)).

• Mark the box for “temporary employment” if the employment lasts for a limited period of time, usually a few months, but not longer than 12 months. It typically includes employment where the worker states that the worker does not intend to remain in that employment indefinitely, the employer states that the worker was hired for a limited time frame, or the SEA has determined on some other reasonable basis that the employment is temporary. (Section 200.81(k)).

[NOTE: The definition of temporary employment includes employment that is constant and available year-round only if, consistent with the requirements of Section 200.81(k) of the regulations, the SEA documents that, given the nature of the work, of those workers whose children were previously determined to be eligible based on the State’s prior determination of the temporary nature of such employment (or the children themselves if they are the workers), virtually no workers remained employed by the same employer more than 12 months.]

2. (Continued from above)… agricultural OR  fishing work.

• Mark the box for “agricultural work” if the work involves the production or initial processing of crops, dairy products, poultry, or livestock, as well as the cultivation or harvesting of trees. (Section 200.81(a)). The work may be performed either for wages or personal subsistence.

• Mark the box for “fishing work” if the work involves the catching or initial processing of fish or shellfish or the raising or harvesting of fish or shellfish at fish farms. (Section 200.81(b)). The work may be performed either for wages or personal subsistence.

*If applicable, check:

 personal subsistence (provide comment)

• (*) Mark the box for “personal subsistence” if “…the worker and the worker’s family, as a matter of economic necessity, consume, as a substantial portion of their food intake, the crops, dairy products, or livestock they produce or the fish they catch” (Section 200.81(h)). Also provide a comment in the Comments section.

4. (Only complete if “temporary” is checked in 5) The work was determined to be temporary employment based on:

1. worker’s statement (provide comment), OR

• Mark this box if the work was determined to be temporary employment based on a statement by the worker or the worker’s family (e.g., spouse) if the worker is unavailable (provide comment). For example, the worker states that he or she only plans to remain at the job for a few months. Provide explanatory comments in Comments section.

2. employer’s statement (provide comment), OR

• Mark this box if the work was determined to be temporary employment based on a statement by the employer or documentation obtained from the employer. For example, the employer states that he or she hired the worker for a specific time period (e.g., 3 months) or until a specific task is completed and the work is not one of a series of activities that is typical of permanent employment. Provide explanatory comments in Comments section. Attach supporting documentation if available.

3.  State documentation for ____________________ (employer).

• Mark this box upon verification that the State has current documentation to support that the work described in #5 is temporary employment for this particular employer. In other words, the State has verified that of those workers whose children were previously determined to be eligible based on the State’s prior determination of the temporary nature of such employment (or the children themselves if they are the workers), virtually no workers remained employed by the same employer more than 12 months, even though the work may be available on a constant and year-round basis.

• Employer. Identify the employer, whether it is the name of or code for a farmer, a grower, a business, or a corporation, where the worker either sought or obtained qualifying work.

Comments Section (Must include 2bi, 4c, 5, 6a and 6b of the Qualifying Move & Work Section, if applicable.). The “Comments section” of the COE allows the recruiter to provide additional information or details that clarify the reasons for the recruiter’s eligibility determination. The recruiter should write clear and detailed comments so an independent party who has no prior knowledge of the eligibility determination can understand the recruiter’s reasoning for determining that the child(ren) is eligible. At a minimum, the recruiter must provide comments that clearly explain items 2bi, 4c, 5, 6a and 6b of the Qualifying Move & Work Section, if applicable. As mentioned previously, these items include the following scenarios:

• The child’s move joined or preceded the worker’s move. If the child(ren) joined or preceded the parent, spouse, or guardian, record the reason for the child’s later move or the worker’s later move.

• The employment is temporary based on the worker’s statement or the employer’s statement. In particular, record the information provided by the worker or employer regarding how long they expect the employment to last. The comment should be of sufficient length to adequately document how the recruiter came to the eligibility decision.

• The child(ren) qualified on the basis of “personal subsistence,” meaning “that the worker and the worker’s family, as a matter of economic necessity, consume, as a substantial portion of their food intake, the crops, dairy products, or livestock they produce or the fish they catch.” (Section 200.81(h)).

• The worker did not obtain qualifying employment as a result of the move. In this case, the recruiter must document that the worker stated that one reason for the move was to obtain qualifying work, AND

  • the worker has a prior history of moves to obtain qualifying work;

  • OR there is other credible evidence that the worker actively sought qualifying work soon after the move, but, for reasons beyond the worker’s control, the work was not available;

  • OR both. Examples of credible evidence include a statement by a farmer that the worker applied for qualifying work but none was available, or a newspaper clipping regarding a recent drought in the area that caused work not to be available.

OME recommends that the recruiter provide additional comments on the COE in the following circumstances and in any other circumstances in which a third party may question the eligibility determination:

• The information on the COE needs additional explanation to be clearly understood by an independent outside reviewer.

• The basis for the preliminary eligibility determination is not obvious. For example, the work is unusual enough that an independent reviewer is unlikely to understand that it is qualifying work. An explanation is needed to enable a reviewer to understand how the preliminary eligibility determination was made.

• The work could be part of a "series of activities" that, viewed together, would constitute year-round employment (e.g., mending fences on a dairy farm and bailing hay could be two parts of year-round ranching with one employer).

• The work may be viewed by an independent reviewer as either temporary or year-round employment (e.g., collecting eggs or milking cows).

• A "move" is of such brief duration or of such a short distance (or both) that one could question whether any migration has occurred (e.g., intra-city or intra-town move that is across school district boundaries).

• A parent or guardian uses a symbol such as an “X” or other valid mark as a signature.

• The person who provided the information on the COE form is not the worker.

• The qualifying move corresponds to school breaks and could be viewed by some as a return from vacation or a move for personal reasons, not a move for economic necessity whereby the worker sought or obtained qualifying work. In this case, the recruiter should explain why the move away was for economic necessity and not for personal reasons.

• The mailing address is different from the child’s physical residence; provide the mailing address as a comment.

• The child(ren) and parent moved from different previous residences. Record the parent’s previous School District/City/State/Country of residence.

Parent/Guardian/Spouse/Worker Signature Section. The interviewee signs and dates the COE on the day the interview is conducted. The interviewee must also write his or her relationship to the child.

I understand the purpose of this form is to help the State determine if the child(ren)/youth listed on this form is/are eligible for the Title I, Part C, Migrant Education Program. To the best of my knowledge, all of the information I provided to the interviewer is true.

Signature, Relationship to the child(ren), Date

The person who signs the COE must be the source of the information contained in the document and should verify any information provided by another source. If the parent is unable to sign his or her name, the parent must mark an “X” in the signature section and the recruiter must print the parent’s name and relationship to the child in the Comments section. If a parent refuses to sign his or her name, the recruiter must document the parent’s refusal in the Comments section and print the parent’s name and relationship to the child.

If a State chooses to include other statements that require a parent/guardian/spouse/worker signature, the State can include the statement above as one of several checkboxes to be completed. However, this statement must be completed in accordance with the instructions for this section.

Eligibility Certification Section. The recruiter signs and dates the COE on the day the interview is conducted.

I certify that based on the information provided to me, which in all relevant aspects is reflected above, I am satisfied that these children are migratory children as defined in 20 U.S.C. 6399(2) and implementing regulations, and thus eligible as such for MEP services. I hereby certify that, to the best of my knowledge, the information is true, reliable, and valid and I understand that any false statement provided herein that I have made is subject to fine or imprisonment pursuant to 18 U.S.C. 1001.

Signature of Interviewer, Date

Signature of Designated SEA Reviewer, Date

At least one SEA-designated reviewer must check each completed COE to ensure that the written documentation is sufficient and that, based on the recorded data, the child(ren) may be enrolled in the MEP. The SEA-designated reviewer must sign and date the COE on the day it was reviewed.

NOTE: If an SEA wishes to add to any portion of the Eligibility Certification Section, it must submit its proposed statement to the Office of Migrant Education for approval.

Attachments

REQUIRED DATA ELEMENTS

Family Data Child Data

Male Parent/Guardian Last Name Residency Date

Male Parent/Guardian First Name Last name 1

Female Parent/Guardian Last Name Last name 2

Female Parent/Guardian First Name Suffix

Current Address First name

City Middle name

State Sex

Zip Birth Date

Telephone Multiple Birth Flag (or MB)

Birth Date Verification Code (or Code)

REQUIRED DATA SECTIONS

Qualifying Move & Work Section

1. The child(ren) listed on this form moved from a residence in ________School district / City / State /

Country______ to a residence in ________School district / City / State__________.

2. The child(ren) moved (complete both a. and b.):

a.  on own as worker, OR  with the worker, OR  to join or precede the worker.

b. The worker, ______First Name and Last Name of Worker_______, is the child or the child’s  parent  spouse  guardian.

i. (Complete if “to join or precede” is checked in 2a.) The worker moved on ____MM/DD/YY____. The child(ren)

moved on ____MM/DD/YY____. (provide comment)

3. The Qualifying Arrival Date was ______MM/DD/YY_______.

3. The worker moved due to economic necessity in order to obtain:

a.  qualifying work, and obtained qualifying work, OR

b.  any work, and obtained qualifying work soon after the move, OR

c.  qualifying work specifically, but did not obtain the work. If the worker did not obtain the qualifying work:

i.  The worker has a prior history of moves to obtain qualifying work (provide comment), OR

ii. There is other credible evidence that the worker actively sought qualifying work soon after the move

(provide comment).

3. The qualifying work,* _________describe agricultural or fishing work________ was (make a selection in both a. and b.):

*If applicable, check:

 personal subsistence (provide comment)

a.  seasonal OR  temporary employment

b.  agricultural OR  fishing work

6. (Complete if “temporary” is checked in #5a) The work was determined to be temporary employment based on:

a.  worker’s statement (provide comment), OR

b.  employer’s statement (provide comment), OR

c.  State documentation for ­­­­­­­­­­­­­_________Employer__________.

Comment Section (Must include 2bi, 4c, 5, 6a and 6b of the Qualifying Move & Work Section, if applicable)

Parent/Guardian/Spouse/Worker Signature Section

I understand the purpose of this form is to help the State determine if the child(ren)/youth listed on this form is/are eligible for the Title I, Part C Migrant Education Program. To the best of my knowledge, all of the information I provided to the interviewer is true. [This section must include fields labeled “Signature,” “Relationship to the child(ren),” and “Date”.]

Eligibility Certification Section

I certify that based on the information provided to me, which in all relevant aspects is reflected above, I am satisfied that these children are migratory children as defined in 20 U.S.C. 6399(2) and implementing regulations, and thus eligible as such for MEP services. I hereby certify that, to the best of my knowledge, the information is true, reliable, and valid and I understand that any false statement provided herein that I have made is subject to fine or imprisonment pursuant to 18 U.S.C. 1001. [The section must include fields labeled “Signature of Interviewer,” “Signature of Designated SEA Reviewer,” and “Date” for each signature.]

Public Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 1 hour and 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary, but the information is needed to obtain or retain benefit under Title I, Part C of the Elementary and Secondary Education Act of 1965, as amended. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-4536 or email [email protected] and reference the OMB Control Number 1810-0662. Note: Please do not return the completed Certificate of Eligibility (COE) to this address.