Rocky Hill Public Schools Change of Address Form 2018-19 School Year
Central Registration Office Information:
Mr. Thomas Kennison, M.S.A., M.B.A.
Registration/Residency Officer
761 Old Main Street, Suite 231 (Town Hall)
Rocky Hill, CT 06067
Phone: (860) 258-7701 Ext. 1177
Fax: (860) 258-7710
Email: kennisont@rockyhillps.com
Instructions:
Please fill-out this online change of address form and submit to my office. Please submit proof of address along with this document. Residency requirements are located at the end of this form. You may scan and email, fax or walk in your proof of residency. Please, no pictures or snapshots because they print out poorly. Questions, please call Mr. Kennison at (860) 258-7701 Ext 1177. Please note, one form for each student is required.
Student Information:
Student's First Name *
Your answer
Student's Middle Name
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Gender *
School (Please select one) *
Grade *
Required
Student Address Information:
Student's Old Address *
Your answer
Student's New Address *
Your answer
Student's Mailing Address (If Different than New Address)
Your answer
Student's Best Contact Number (XXX-XXX-XXXX) *
Your answer
Resides With *
Bus Information:
Please be advised, bus changes will take place after new proof of address is submitted to the Residency Office with this form. In addition, bus changes may take up to three school days to process for new stops. Thank you for your understanding.
Does Your Student Require New Bus Pick-up/Drop-off Information? *
Bus Pick-up/Drop-off Details:
Please provide information on how your student will get to and from school.
How will your student will arrive to school? *
How will your student will arrive home? *
Daycare Information (If applicable):
Please provide information on your student's daycare if applicable.
Name of Daycare Provider
Your answer
Daycare Address
Your answer
Daycare Phone (XXX-XXX-XXXX)
Your answer
Mother's Information:
Natural or Adoptive Mother Only
Mother's First Name
Your answer
Mother's Last Name
Your answer
Mother's Address (if different)
Your answer
Mother's Home Phone (XXX-XXX-XXXX)
Your answer
Mother's Day Phone (XXX-XXX-XXXX)
Your answer
Mother's Cell Phone (XXX-XXX-XXXX)
Your answer
Mother's Email Address
Your answer
Father's Information:
Natural or Adoptive Father Only
Father's First Name
Your answer
Father's Last Name
Your answer
Father's Address (if different)
Your answer
Father's Home Phone (XXX-XXX-XXXX)
Your answer
Father's Day Phone (XXX-XXX-XXXX)
Your answer
Father's Cell Phone (XXX-XXX-XXXX)
Your answer
Father's Email Address
Your answer
Guardian's Information (Other than natural parent):
Includes step-father or step-mother, domestic partners, grandparents, etc.
Guardian 1: First Name
Your answer
Guardian 1: Last Name
Your answer
Guardian 1: Home Phone
Your answer
Guardian 1: Day Phone (XXX-XXX-XXXX)
Your answer
Guardian 1: Cell Phone (XXX-XXX-XXXX)
Your answer
Guardian 1: Email
Your answer
Guardian 2: First Name
Your answer
Guardian 2: Last Name
Your answer
Guardian 2: Home Phone (XXX-XXX-XXXX)
Your answer
Guardian 2: Day Phone (XXX-XXX-XXXX)
Your answer
Guardian 2: Cell Phone (XXX-XXX-XXXX)
Your answer
Guardian 2: Email Address
Your answer
Emergency Contact Information
Other than parents/legal guardians. School will always call parents first. If no emergency contact persons are available, please leave blank.
Emergency Contact 1: Full Name
Your answer
Emergency Contact 2: Best Contact Number (XXX-XXX-XXXX)
Your answer
Emergency Contact 2: Full Name
Your answer
Emergency Contact 2: Best Contact Number (XXX-XXX-XXXX)
Your answer
Emergency Contact 3: Full Name
Your answer
Emergency Contact 3: Best Contact Number (XXX-XXX-XXXX)
Your answer
Automated Alert Messages (all announcements):
School cancellations, delays, early releases, school events, etc.
Phone 1 (xxx-xxx-xxxx)
Your answer
Text 1 (xxx-xxx-xxxx)
Your answer
Email 1
Your answer
Phone 2 (xxx-xxx-xxxx)
Your answer
Text 2 (xxx-xxx-xxxx)
Your answer
Email 2
Your answer
Residency Verification Sign-off and Parent/Guardian Signature:
In accordance with Sections 10-186, 10-220 and 10-253(d) of the Connecticut General Statutes, the Rocky Hill Board of Education requires proof of residency in Rocky Hill during the school enrollment process. Individuals seeking to enroll in Rocky Hill Public Schools will therefore be required to provide such proof. All residency documents submitted are subject to verification by the Rocky Hill School Residency Officer. Pursuant to Section 10-253d of the Connecticut General Statutes, a child living with any individual other than the child’s parent/legal guardian can attend school in the district only if such residence is: 1) permanent; 2) provided without pay; and 3) not solely for the purpose of gaining school accommodations. In accordance with the statute, the district has the right to require proof that all three requirements have been satisfied. In accordance with Section 10-186(b)(4) of the Connecticut General Statutes, if it is determined that a student has been enrolled in Rocky Hill Public Schools in violation of the statutes referenced above, the Rocky Hill Board of Education has the right to assess tuition. Such tuition would be based on the district’s per diem net current local educational expenditure (as defined in section 10-261), multiplied by the number of days the student was improperly enrolled in Rocky Hill Public Schools. In addition, the statute provides that the Board of Education may seek to recover the amount of the assessment through available civil remedies.

By signing below, I have read and understand the residency requirements concerning enrollment in Rocky Hill Public Schools. I understand the Rocky Hill Board of Education has the authority to impose tuition as outlined above if the student(s) being enrolled are not in fact residents of Rocky Hill. I also understand that the Board of Education has the right to pursue any and all legal remedies in the event that any student is enrolled improperly. I hereby give consent to the Rocky Hill School Residency Coordinator to verify any information pertaining to the permanent residency of all pertinent parties involved in this registration.
Electronic Signature of Parent or Legal Guardian *
Your answer
Date: *
MM
/
DD
/
YYYY
Residency Requirements For Changes of Address:
Required documents for a change of address include providing Central Registration with one item from Category A and one item from Category B. Electronic copies are acceptable.

For your convenience and to speed-up the the change of address process, residency documents may be scanned and emailed or faxed to my office. No photos or snap shots, please.

Email is kennisont@rockyhillps.com. Fax number: 860-258-7710.


CATEGORY A:

· Mortgage statement
· Lease - must be unexpired, signed by lessor/lessee and dated
· Copy of property deed if no mortgage statement available
· Section 8 agreement with dates of tenancy
· Notarized Landlord Residency Affidavit if no lease exists, lease is expired, or lease is weekly or month to month (available “only” from the RHPS Residency Coordinator)

CATEGORY B:

Current utility bill or Service Verification Letter from utility showing service address. Must be from current or prior month.

Examples:
· Electricity
· Natural Gas
· Phone (landline only)
· Cable or satellite
· Water

The Rocky Hill Board of Education prohibits discrimination or harassment on the basis of race, color, religious creed, age, marital status, military or veteran’s status, national origin (including immigration status), ancestry, sexual orientation and past or present learning disability, physical disability or mental disorder. The Rocky Hill Board of Education guarantees compliance under Titles VI and VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments Acts of 1973, section 504 of the Rehabilitation Act of 1973, the American with Disabilities Act of 1991 and Connecticut General Statutes 46a-60.

Submit
Never submit passwords through Google Forms.
This form was created inside of Rocky Hill Public Schools. Report Abuse - Terms of Service - Additional Terms