SYLVANIA SCHOOLS
Change of Address

Name of Student: 							 School: 	_______   School:__________
										 (Current)		   (New)

According to Ohio Revised Code, school districts have the right to request verification of legal residency. I am aware of the Policy of the Sylvania School District, which states that if a student is found to have residency in our district by using false or inaccurate information, the student will be dismissed/excluded from school until resolved by school Administration.  If determination is made that there was an attempt to defraud the District, restitution will be sought legally.  The District may file charges with local authorities to prosecute and recover reimbursement for tuition and legal fees from the parties responsible.  Those responsible will be held liable for all costs incurred while the student was enrolled in the District based on the daily rate for the current school year.

Previous Address:  ________________________________________________City______________Zip Code___________

Has there been a change in custody?      Yes___    No___   (If Yes, please provide current court document)

Please fill in and sign the appropriate section(s).  Please supply a copy of the applicable proof of residency to this form.
SECTION A:  Please provide Lease Agreement, Purchase Agreement, or Building Contract and Utility Bill within:	(Please check one)									       
Parent(s) Name:(print)  ___________________________________       ___Reside     ___Own/Rent      ___Purchased     ___Building 
							        	        30 days  	 30 days	                 60 days	                90 days

______________________________________________________________________________________________________________________________________________
New Address (Street Number and Street Name)				(City)				(Zip Code)

				________ 	_______________
Signature of Parent/Guardian		Date

SECTION B:  for Foster Parents or Guardians: Please provide proof of residency

I am the Foster Parent or Legal Guardian of 								.  This child is presently residing in my residence at 								 on a full-time basis.  I have supplied school officials with court documents verifying the custody order.
									 					 
Signature of Foster Parent or Guardian						Date
SECTION C:   Statement of Domicile:  Please provide proof of residency as stated in instructions

I, 									 declare that 				_______
		District Resident									Student
physically resides in my home at 										_________________

on a full-time basis with 						____.  They have NO other residence listed on documents, 
				Parent/Guardian
and further declare that they eat, sleep, and maintain daily activities at this residence.

						 	_____________________	__________________________________
Signature of Person Providing Residence			Date			Phone Number of District Resident

__________________________________________________________		_____________________	__________________________________
Signature of Parent/Guardian				Date			Phone Number of Parent/Guardian

Signature of Notary 							 Notary Phone #