Mckay Scholarship Program Guardian Issue Form Page 2

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M
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2
C
AY
UARDIAN
SSUE
ORM
AGE
Please indicate the reason for your change request. You must provide a copy of the documentation listed
below to verify the reason for change.
Reason for Change
Required Documentation *
□
Marriage certificate
Parent/guardian change of name due to
Social Security card with new legal name
marriage
□
Death certificate
Parent/guardian change of name due to
Social Security card of new guardian
deceased spouse
□
Court documentation
Change in guardian
Social Security card of new guardian
□
Power of Attorney (POA holder may not be the
Parent/guardian unable to sign
school or any school staff.)
Social Security card of POA holder
□
Power of Attorney (POA holder may not be the
Child moved to group home
school or any school staff.)
Parent/guardian Social Security card
□
Court documentation
Foster parent
Foster parent/guardian Social Security card
□
Consult your Regional Manager
Other _________________________
* Additional documentation may be required.
Fax or mail the completed Guardian Change Form (both pages) and accompanying documentation
to the attention of your Regional Manager.
Fax:
850-245-0875
Mail:
Office of Independent Education and Parental Choice
325 W. Gaines Street, Room 1044
Tallahassee, FL 32399-0400
Rev.3/05/12
• S
1044 • T
, FL 32399-0400 • (800) 447-1636 • Fax (850) 245-0875
325 W. G
S
AINES
TREET
UITE
ALLAHASSEE

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