South Pike School District

Residency Registration Checklist

Student Name: __________________________________________________________

Parent Name: ___________________________________________________________

                                             ^{(As stated on birth certificate)}

Legal Guardian Name: ___________________________________________________

                                                                 ^{(Must have legal document signed by judge)}

Parent/Legal Guardian Address: _____________________________________________

_____A. Documents provided by Parent/Guardian (Two required)

This must be a Utility Bill _______________________

The second can be one of the following:

_____ 1. Filed Homestead Exemption Application Form

_____ 2. Mortgage Documents or Property Form

_____ 3. Apartment or Home Lease

_____ 4. Driver’s License

_____ 5. Voter Precinct Identification

_____ 6. Automotive Registration

_____ 7. a. Affidavit of Residency

               b. District Representative Personal Visit

_____ 8. Other approved documentation

*These two forms of documentation 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 a sworn Affidavit stating his/her relationship to the student, and that the student will be living in his/her 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 under II, 1(c) (2) of the State Residency Verification Procedures.

Date: ______________________________   __________________________________

                                                                                                                        ^{(School District Representative)}