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.
Date of Birth
Name of person completing this form.
Provide a phone number where we can reach you if necessary.
Are you the Legal Guardian?
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This form was created inside of South Jefferson CSD.