FAMILY REQUEST FOR ADDRESS CHANGE

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The information in this form will be applied district wide, and you will only need ONE FORM SUBMITTED PER FAMILY. Please go to your Parent Portal account under Household Information/Family Members to view your current information. You can also update your home phone number via your Parent Portal Account.

BUSING INFORMATION

Transportation will route to/from the primary address for all Kindergarten through 9th grade students. All high school students must request busing if needed. Busing information can be found in your Portal account. It will take 3-5 days for updated busing information to appear in your Portal. If you need to arrange alternate busing please complete the necessary forms on our website.

Parent/Guardian Name *

First and last name please

List All STUDENTS Currently Attending CCSD *

List all students, separated by a comma

Email Address *

Cell/Home Phone Number in Case Questions Arise *

Please specify if it is a cell or home phone

Will Both Mom and Dad live in New Household? *

Yes, both parents live at new address

No, parents live in separate households

Other:

This Address Change is For: *

All family members are moving to the new address

Only specific people are moving from the current household

Primary, create new

Secondary, create new

Primary and secondary are switching

Other:

Please list all family members moving to the new address. *

Please include all children, adults and relatives making the move.

Did You Move into Another Families Household? *

Yes

If Yes, who?

Please list first and last name, along with the relationship to the student.

Previous Street Address *

Previous City *

Previous Zip *

New Street Address *

New City *

New Zip *

Previous County *

Linn

Johnson

Iowa

Benton

Other:

New County *

Linn

Johnson

Iowa

Benton

Other:

Effective Date of New Address *

YYYY

Does Your New Residence Have a PO Box Number? *

In order to process PO Box numbers, we need to have a physical address on file.

Yes

If Yes, Please List the Number, City and Zip

It is important that you include the city and zip here

Is This New Address in the College Community School District? *

Yes

If Your New Address is Out of District:

My child/ren will be transferring to their new district.

My child/ren will finish the school year at CCSD and then transfer to new district

I would like to talk to someone about open enrollment

Other:

Clear selection

Are You an Employee of CCSD? *

Employees please update information in Employee Self Serve

Yes

Does Any Child in your Household have an IEP (Individualized Education Program) *

Yes

If yes, please provide name of student and building they attend.

Additional Comments:

Please tell us anything else you think we might need to know to complete this request and make accurate changes in our Student Information System.

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