Certificate of Residency for Apartment Form C South Pike School District by jii25615


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									Form C
                                    South Pike School District
                                   Residency Registration Form

STUDENT NAME: ________________________________________________________

PARENT(S) NAME(S):_____________________________________________________
                                           (As stated on birth certificate)

LEGAL GUARDIAN’S NAME: ________________________________________________
                                                    (Must have legal documentation)

PARENT/GUARDIAN _____________________________________________________

PARENT/GUARDIAN _____________________________________________________

   A. Two (2) Documents of Residency are Required

              _____ One Must be a Utility Bill

       The second can be one of the following.
            _____ Filed Homestead Exemption Application Form
            _____ Mortgage Documents or Property Deed
            _____ Apartment or Home Lease
            _____ Driver’s License
            _____ Voter Precinct Identification
            _____ Automobile Registration
            _____ Affidavit of Residency
            _____ District Representative Personal Visit
            _____ Other Approved Documentation
       These two forms must have the same physical address.

_____ B. Student is living with legal guardian and a certified copy of the Court Decree, or petition, if
pending, was received declaring the district resident to be the legal guardian of the student and further
declaring that the guardianship was formed for a purpose other than establishing residency for school
district attendance purposes.

_____ C. Student is living with an adult other than parent or legal guardian and the adult has provided
proof of legal guardianship court appointed and a sworn affidavit stating his or her relationship to the
student, and that the student will be living on his or home full time and fully explaining the reasons (other
than school attendance zone or district preference) for this arrangement and the School Board or its
designee has made the necessary factual determination user II, 1 ( c ) (2) of the State Residency
Verification Procedures.

       All Documentation Must Be On File within One Week after Enrollment

Date: ____________________                     _______________________________________
                                                                       School District Representative

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