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Book Policy Manual
Section 5000 - Students
Title Enrollee Verification of Residence Form
Code 5111-R Form 1
Status Active
Last Revised March 24, 2022
Colchester Public Schools
ENROLLEE VERIFICATION OF RESIDENCE FORM
Parent/Legal Guardian Statement
I, (print name)_________________________________________________________________________________________,
reside at (address)______________________________________________________________________________________.
I am the parent/legal guardian of (student):____________________________ DOB:__________________,
who resides with ______________________at (address) ________________________________________.
Phone number:_____________________________________.
Parent/Caregiver email:_____________________________________________________.
I certify that the above-named student resides full time (7 days a week) at the permanent address listed above. (If there is
shared custody, a legal document reflecting at least 50% residency in Colchester will be required.) I understand that falsification
of any information or documents required for this verification may lead to the disenrollment of the above-named student and
may lead to liability for tuition and possible prosecution under the criminal statutes of the State of Connecticut.
Parent/Legal Guardian signature:______________________________________________ Date:____________
FOR OFFICE USE ONLY
In order to verify district residence, the child (if over 18), parents or caregivers, or an emancipated minor must sign above and
provide documents from any of the items listed below:
____ SECTION ONE: Proof of identification (photo ID) Provide ONE.
___a. Driver’s license
___b. Non-Driver photo ID
___c. Valid passport with photo
____ SECTION TWO:
Homeowners:
___ Deed to home, current mortgage bill, or homeowner's property tax statement
Renters:
___ Signed active lease or rental agreement that is also signed by your landlord with landlord’s contact number
____ SECTION THREE: Residency verification; Provide TWO proofs of residency documents dated within 30 days in the same
name and to the same address:
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___ Current utility bill (water, light, gas or cable)
___ Home telephone bill
___ Other
____ SECTION FOUR:
Proof of Student's age:
___ Photocopy of a birth certificate
___ Earlier school records
___ State-issued identification document
___ Driver’s license, passport, etc.
___ Parent’s affidavit or unsworn statement as to a student’s age
___ Physician’s certificate verifying a student’s age
___ Immunization records
___ Other
If the student is living permanently in a dwelling that is rented, owned, or occupied by a resident of Colchester, who is not the
student’s parent/guardian, that resident of Colchester must bring documentation mentioned in Sections Two and Three,
present photo identification and complete the Host Statement. The parent/guardian must complete the Parent Statement. A
Residency Affidavit must be completed by the parent and host together. Please contact the Director of Pupil Services and
Special Education for Colchester Public Schools if the student’s residence is not permanent.
Documents seen by
(signature):________________________________________________________________________________
Date: _____________________________________
Revised: 3/29/22
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