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Residency Verification Affidavit

Note: School of Choice Students do NOT have to complete this form.

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.

Residency is defined as the location at which you and the child sleep. 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.

Our address is:



 Verification of Residency

   ⃣  Driver’s License

   ⃣   Lease Agreement

   ⃣ Moving Bill

   ⃣   Voter Registration

   ⃣  Purchase Agreement

   ⃣   Utility Bill

   ⃣  Insurance Forms

   ⃣   Other (please specify) ________________________________________

 Student Resident Status

   ⃣   Living with family

   ⃣   Separated from family

   ⃣  Foster Care Pending

   ⃣  Living in Shelter

   ⃣  In a motel, car, campsite

  ⃣  With more than one family

   ⃣ Unaccompanied youth

   ⃣   Other (please specify) ________________________________________

Falsification of residency is a crime and punishable as a felony in the state of Michigan. Local property taxes fund local school districts and therefore legal residency is a requirement.

I hereby certify that I, _____________________, the parent/legal guardian of ________________, and the aforementioned child are indeed legal residents of the Bentley Community School District.

Signature of Parent/Guardian _______________________________________________ Date_____________________