Student Change of Address Form
(Residency Questionnaire)This form is to be used if a student's primary residence changes during the school year (including address changes within the district). This questionnaire is intended to address the McKinney-Vento Act, 42 U.S.C. 11435. The Answers to this residency information help determine the services the student may be eligible to receive.
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Student's Name *
Date of Birth *
Name of person completing this form.
Phone number
Provide a phone number where we can reach you if necessary.
Are you the Legal Guardian?
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