Affidavit Of Residence Form Page 2
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1
2DELIVER THE COMPLETED REQUEST FOR TEMPORARY ASSIGNMENT, AFFIDAVIT OF RESIDENCE AND TWO PROOFS OF
RESIDENCE TO YOUR ZONE SCHOOL.
Form must be printed, legible and complete or it will be returned to the school
First Year Affidavits: One proof in your name and one proof in the owner/lease holder’s name OR two proofs in owner/lease holder’s name
Beyond First Year Affidavits: One proof MUST be in your name and one proof in the owner/lease holder’s name
REQUEST FOR TEMPORARY ASSIGNMENT
(PARENT AND CHILD ARE STAYING WITH RELATIVE/FRIEND)
20_____ - 20______
Is this a full and complete family move?
YES or
NO
(School Year)
1.
Name of Student: __________________________________________________________________
_____________
_________
(Last)
(First)
(Middle)
(I. D. Number)
(Grade)
2.
Student's Address: __________________________________________________________________
_________________________
(Do Not Use Routes or P. O. Box Numbers)
(City)
3.
Name of Parent: ____________________________________________________________________________
________________
(Home Phone)
4.
Parent's Address: _____________________________________________________________________________
________________
(Work Phone)
5.
Parent's Mailing Address ______________________________________________________________________
________________
(Zip Code)
Parent's Previous Address ______________________________________________________________________
________________
(Zip Code)
6.
School where student most recently attended: ______________________________________________________________________
7.
School to which student is zoned: ___________________________________________Center Number: _______________________
FOR HIGH SCHOOL STUDENTS ONLY PLEASE CHECK APPROPRIATE BOX
Do you participate in high school sports?
YES or
NO
List the Sport (s) ______________________
*If this affidavit is not a full and complete move by everyone at the previous address, the student will only be eligible the
second semester for any sport which was not already in season during the first semester. Contact the District Director of
Athletics for eligibility questions before submitting this affidavit for approval.
** If this is the second high school your student will be attending this school year, your child’s eligibility to participate in sports at the new
school must be determined. (FHSAA Bylaw 9.3.2)
******Request for Temporary Assignment/Affidavit of Residence must be completed each school year******
______________________________________
_____________________________________________
(Date)
(Signature of Parent)
Two Current (dated within 90 days) Proofs of Residence Required – envelopes are NOT accepted
Examples of acceptable documents reflecting name and residential street addresses are as follows:
•
Current Apartment or home lease agreement(with signature page where both tenant and landlord have signed), mortgage document,
property tax record, rent receipt, home owners insurance
•
Current utility bill (electric, gas, water) cable, home or cell phone bill
•
Current Voter registration document, State of Florida identification card
•
Current Proof of government benefits (disability, Medicare, food stamps, Department of Children and Families (DCF)
correspondence).
•
Current Florida driver’s license, automobile registration, automobile insurance
OFFICE USE ONLY
APPROVED
DATE PROCESSED__________
RECEIVED DATE:
DENIED
TRANSFER CODE___________
STUDENT ASSIGNMENT SPECIALIST INITIALS_____
Revised 07-2015
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