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                    ORANGE UNIFIED SCHOOL DISTRICT
                          Office of Child Welfare and Attendance
                            1401 N Handy St. - Orange, California 92867 (714) 628-4060
                                          www.orangeusd.k12.ca.us


            RESIDENCE VERIFICATION FORM
Dear Parent/Guardian:

The district may ONLY enroll students when the student & the parent(s) or guardian(s) reside within school
district boundaries (Education Code 48204) or students who have approved inter-district transfer agreements
to O.U.S.D. schools where there is space availability & where families residing within O.U.S.D. have been
provided the first priority for enrollment.

California Government Code 244 states: In determining the place of residence the following
rules shall be observed: (a) It is the place where one remains when not called elsewhere for labor or other
special or temporary purpose, and to which he or she returns in seasons of repose. (b) There can only be one
residence. (c) A residence cannot be lost until another is gained. (d) The residence of the parent with whom
an unmarried minor child maintains his or her place of abode is the residence of such unmarried minor child.
(e) The residence of an unmarried minor who has a parent living cannot be changed by his or her own act. (f)
The residence can be changed only by the union of act and intent. (g) A married person shall have the right to
retain his or her legal residence in the State of California notwithstanding the legal residence or domicile of his
or her spouse.
“Residency” means the student is living at the address specified, with the parent or legal guardian. Each
student may claim only one residence and the address must be located within O.U.S.D. school district
boundaries. Although O.U.S.D. has attendance areas for each school, attendance at specific schools is not
guaranteed. O.U.S.D. students may be assigned to other schools when school capacity has been reached,
when grade levels are filled, or for disciplinary reasons. Parents may also request specific schools during the
annual open enrollment program, which is posted on the district website.
This form has been provided to help you verify the location of your residence. Residency verification is a
parent’s responsibility and falsification of information provided on this document will be grounds for immediate
cancellation of enrollment. In addition, false information for students participating in CIF athletic activities may
result in forfeitures and ineligibility. Please provide the information requested below so that we may proceed
with enrolling your child legally into the Orange Unified School District:

Student’s Name: ___________________________________________ DOB:________________ Grade:________

Student’s Name: ___________________________________________ DOB:________________ Grade:________

Student’s Name: ___________________________________________ DOB:________________ Grade:________

Parent/Guardian’s Name: ____________________________________ School Requested: __________________

Address:_______________________________________________________________________________________
                        Address (Include Apt. #, etc.)     City             Zip Code

Actual Residence Phone # (_____)_____________________          Cell Phone # (_____)_______________________
                    Please verify residence by completing the following:

If you are renting or leasing your residence and need to verify your address for the purpose of a student’s
enrollment, please provide either (1) a copy of the agreement on PROPERTY MANAGEMENT LETTERHEAD
or (2) if you are subleasing an apartment or room, have the original renter complete the form below:


Manager/Landlord/Sub-lease Signature:
I certify to the Orange Unified School District under penalty of perjury that the following parent(s)/guardian(s)
and children are living at the address listed in compliance with California Government Code 244 and that this is
their true and accurate residence:

Residing Parents/Guardian(s): _______________________________________________________
Residing Children: ________________________________________________________________
______________________________________                    ______________           ______________________
             Manager/Landlord Signature                          Date                        Phone #


         OTHER CIRCUMSTANCES - I NEED ASSISTANCE                                 (Reason must be given)

I will need assistance with residency verification from the school’s staff or district’s staff prior to enrolling my
child(ren) at this school, as I am unable to provide the above documentation for the following reason:

________________________________________________________________________________
________________________________________________________________________________
Please review all statements listed on this “Residence Verification Form.” Do not sign this
form if any of the statements are inaccurate or false.

I DECLARE UNDER PENALTY OF PERJURY (PENAL CODE 126) UNDER THE LAWS OF THE
STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. IN ADDITION, I
HEREBY AGREE TO IMMEDIATELY REIMBURSE THE ORANGE UNIFIED SCHOOL DISTRICT
FOR ALL COST INCURRED DUE TO FALSE INFORMATION THAT I HAVE PROVIDED TO THE
DISTRICT.


___________________________________________________                           _________________________
              Signature of Parent/Guardian                                               Date
        In the event of any questions, please contact Mike Pollok in the Office of CWA at (714) 628-5424.

                                             (For Official Use Only)
 ___ Approved       ___ Denied      _________________________________________           _____________________
                                       Principal/Designee’s Signature                        Date
    Comments:

				
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posted:8/17/2011
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Description: Sub Lease Verification Form document sample