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Apr 10, 2024 2:11 PM GMT
(2 years ago)
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[email protected] (Becky Putman)
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In Progress
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This document is a IN PROGRESS Form.
RESIDENCY VERIFICATION AFFIDAVIT
According to State Attorney General Opinion No. 5925, school districts have the right to request proof of pupil
residency. By signing this affidavit, you are affirming that the address given on all enrollment forms is the legal
residence of the parent or guardian enrolling the student and is the residence of the student.
If you are living in the home of another person without a rental or lease agreement, that person must sign this
document and prove their residency. If this enrollment is in compliance with the McKinney-Vento Act, the Homeless
Form must be attached in lieu of proofs of residency.
Verification of residency needs to be made as follows:
Choose one(1) of the following (Please indicate submitted verification):
_____ Mortgage, Lease, Rental Agreement OR _____ Property Tax Statement
Choose two(2) of the following (Please indicate submitted verification):
____Moving Bill ____Property Tax Payment ____Driver’s License
____Utility Bill ____Mortgage/Rent Receipt ____Other (specify below)
____Insurance Forms ____Business Mail ___________________________
___________________________
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________________________________________________________________________________________________
Student Name Date
________________________________________________________________________________________________
Parent or Guardian Signature Date
________________________________________________________________________________________________
Signature of Person with Whom Residing (if Applicable) Date
________________________________________________________________________________________________
Street Address City State Zip
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PLEASE READ CAREFULLY
If you are NOT a resident of the Northwest Community Schools District, one of the following needs to be
completed prior to enrollment:
_____Schools of Choice Form (only available during open enrollment)
_____District Release Form (State Aid Release)
If you have not completed the above, please contact the Administration Office for more information (517-817-4726).
FOR SCHOOL STAFF ONLY (REQUIRED)
________________________________________________________________________________________________
Signature of Staff Person Enrolling Student Date