PROOF OF RESIDENCE Family Living With Another Family

PROOF OF RESIDENCE
Family Living With Another Family
1. The person who owns/rents the property must sign the Proof of Residency Affidavit verifying that the
parent/guardian and the student are residing with them at the present time. The Affidavit must be
notarized. If the residence is an apartment complex, a letter from the property manager/owner
establishing permission to reside there may also be required.
2. The person who owns/rents the property must provide at least one address verification document that
establishes their connection to the property. The verification should be in the form of a contract, lease,
utility bill, water bill, cable bill, phone bill, or other service bill.
3. The parent/legal guardian will be required to provide two address verification documents for the stated
address. Acceptable address verification documents are: 1) Paycheck Stub 2) W-2 Statement 3) Car
Insurance 4) Bank Statement 5) State/Federal Supported Services (DSS, SCDMV, SC Dept of
Employment & Workforce, Social Security Administration, SC Student Loan, SC Child Support
Enforcement, etc). Parents/guardians may also be required to provide proof that they are no longer
residing at their previous address. This proof can be in the form of a letter from the previous landlord (on
letterhead), a cancellation of service notice, or a notarized statement.
4. A completed Application Form and Photo ID are to be submitted with the Proof of Residency Affidavit.
Please Note:
1. Once the two address verification documents are provided, an assignment for the term of one school year
will be made. The assignment will expire the last day of the current school year. If the parent/legal
guardian has recently moved and does not have the two specified address verification documents, a 10day temporary assignment can be made. Schools have the authority to withdraw students after the
temporary assignment expires if the necessary documentation is not received. The Proof of Residence
process must be completed and renewed annually.
2. If the temporary Proof of Residence requirements are not completed by the end of the school year, the
parent/guardian will not be issued a temporary Proof of Residence assignment for the next school term if
they are residing at the same address. The parent/guardian must have all required documents to
establish Proof of Residence in cases as such.
3. FEDERAL LAWS PROHIBIT THE USE OF GOVERNMENT UNITS (SECTION 8) AS SHARED
HOUSING. Parent/guardian and student must be listed on the lease for government housing.
Family Recently Moved
1. Families that have recently moved and are unable to provide a lease and utility statement (verification) to
the school must obtain an assignment letter from the Registrar’s Office. A family that has a copy of their
contract/lease and order forms for electrical service, telephone service, water service, or cable service
should provide the documents directly to the school.
2. The Registrar’s Office will issue temporary assignment letters to families who are in transition to include
but not limited to military relocations and real estate closings. Verification of the transition must be
provided in the form of a copy of the military orders, a letter from the realtor indicating a closing date, or
similar document(s).
3. A completed Registrar’s Office Application Form is to be submitted with the Proof of Residence Form.
Please Note:
Temporary assignments will only cover the time period needed to complete relocation and/or to obtain
two address verification documents. At that time, the Registrar’s Office will issue an assignment letter.
If currently residing outside of Richland One, out of district tuition fees will be assessed pending
relocation to Richland One.
REGISTRAR’S OFFICE APPLICATION FORM
Received
Richland County School District One
Parent(s)/Guardian(s) Name____________________________________________________________________________
Street Address____________________________________ Apt. /Lot______ City_________________ Zip_____________
Home Phone ___________________ Work Phone __________________ E-mail __________________________________
BASIS FOR REQUEST
___Child Care
___Administrative (Severe Hardship)
___Employee Option (Worksite: __________________)
___Programmatic (Program: ______________________)
___JFAB (To Complete School Year Only)
___Proof of Residence
___Court Order
___Guardianship
___Out of District Acceptance
___Out of District Release
Check if Applicable
AAP
Sp. Ed.
STUDENT’S NAME(S)
Sex
Race
______________________________
___
_______
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_________
______________________________
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_______
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_________
______________________________
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_______
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_________
______________________________
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_______
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_________
______________________________
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_________
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Is this a renewal? Yes / No
Grade Level
Last application date? _________
Have you submitted any paperwork for the current school year before now?
Yes / No
Are any student(s) listed above suspended or expelled? Yes/No
If yes, please name _______________________________________________________________________
DO NOT WRITE BELOW THIS LINE!
Notes:
FOR OFFICE USE ONLY.
School(s) Zoned for Residence
CPU#_____ TMS#_____
Elementary_____________________________________
Middle_________________________________________
High__________________________________________
 No Documented Hardship
 No Space Available
 Basis Not Applicable
Requested Zone(s)
CPU#_____ TMS#_____
Elementary_____________________________________
Middle________________________________________
Request Granted___________
Request Denied ___________
Temporary/Expires_______________
Permanent_____________________
High__________________________________________
Date_________________
_________________________________________________
Signature of Staff Member Processing Request
Registrar’s Office ∙ 1310 Lyon Street Columbia, SC 29204 ∙ Phone: (803) 231-6944 ∙ Fax: (803) 231-6949 ∙ Website: http://www.richlandone.org/
PROOF OF RESIDENCY AFFIDAVIT
(To be completed by Parent or Legal Guardian)
I, _____________________________________, certify that I am living in a shared housing situation located at
_____________________________________________________________________________________________.
I request that the following school age children who are residing at the same address be permitted to enroll
in Richland County School District One.
Name of Student
Grade Level
Date of Birth
___________________________________________
____________
_____________
___________________________________________
____________
_____________
___________________________________________
____________
_____________
___________________________________________
_____________
_____________
It is understood that the above named student(s) will be permitted to attend Richland School District One
for the current school year only based upon proof of residency. If a change in the legal residence occurs, it
is the responsibility of the parent(s)/legal guardian(s) and homeowner to notify the school(s) immediately.
I understand that if it is found that I have willfully and knowingly provided false information in this
affidavit to enroll a child in a school which the child is not eligible, I may be found guilty of a
misdemeanor and, upon conviction, must be fined an amount not to exceed two hundred dollars or
imprisoned for not more than thirty days and also must be required to pay Richland County School
District One an amount equal to the cost to the district for educating the child during the period of
enrollment. FEDERAL LAWS PROHIBIT THE USE OF GOVERNMENT UNITS AS “SHARED HOUSING”.
I agree that Richland School District One may use any methods that is deems necessary to verify any of the
information set forth in this affidavit. I confirm that all of the information herein is true and accurate.
______________________________
______________________________
___________________________
______________________________
______________________________
___________________________
Signature, Home Owner/Renter
Signature of Parent/Legal Guardian
Print Name
Print Name
Telephone Number
Telephone Number
Sworn and subscribed before me this _____ day of _____________, 20_____.
________________________________________
Notary Public of South Carolina
_________________________________
My Commission Expires
___________________________________________________________________
To Be Completed By Registrar’s Office Only
Zoned School: ________________________________________________ Date____________________________________
Signature of Staff Member Processing Request____________________________________________________________
Richland County School District One
General Consent Form
I hereby authorize Richland County School District One, to verify my address for the
purpose of enrolling the child (ren) or so they may remain enrolled. I further authorize
the following specific establishments, but do not limit the authorization to release
information from these companies: SCE&G, Mid-Carolina Electric, City of Columbia,
Bellsouth, AT&T, Time Warner Cable, Fairfield Electric, Tri-County Electric, etc.
The information obtained by Richland School District One is only to be used by
Richland School District One for verification purposes.
A photographic or FAX copy of this authorization may be deemed to be equivalent to
the original and may be used as a duplicate original.
_____________________________________________________________________________
Signature, Home Owner/Renter
Date
_____________________________________________________________________________
Signature of Parent/Legal Guardian
Date
PROOF OF RESIDENCE
Additional Information
Parent/Guardian Previous Address: ___________________________________________________________________________
City: ________________________________________________
State: ______
Zip: _____________________
Parent/Guardian Previous Telephone Number: __________________________________________________
Student Last School Attended: ________________________________________________________
Last School’s Location: _______________________________________________________
Parent/Guardian Previous Address: ___________________________________________________________________________
City: ________________________________________________
State: ______
Zip: ______________________
Parent/Guardian Previous Telephone Number: __________________________________________________
Student Last School Attended: ________________________________________________________
Last School’s Location: _______________________________________________________
Parent/Guardian Previous Address: ___________________________________________________________________________
City: ________________________________________________
State: ______
Zip: ________________________
Parent/Guardian Previous Telephone Number: __________________________________________________
Student Last School Attended: ________________________________________________________
Last School’s Location: _______________________________________________________
Parent/Guardian Previous Address: ___________________________________________________________________________
City: ________________________________________________
State: ______
Zip: __________________________
Parent/Guardian Previous Telephone Number: __________________________________________________
Student Last School Attended: ________________________________________________________
Last School’s Location: _______________________________________________________