Proof Of Student Identity And Age Form

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AFFIDAVIT
Proof of Student Identity and Age
Virginia State law requires that a birth certificate be presented when a student registers for
school (Section 22.1-3.1, code of Virginia). If none can be produced, an affidavit witnessed by a
Notary Public may be accepted. State law also requires that the school division forward a copy
of this Affidavit and documents used to provide proof of a child’s age and identity to the local
law enforcement agency. Please fill out the form below and return it to the school after it has
been notarized.
__________________________________, being first daily sworn upon oath, based upon his/her
personal knowledge, answers the following questions as noted in his/her handwriting on this and
that attached page, which are propounded by duly authorized officials of the Arlington County
Public Schools concerning a pupil’s identity and age requesting enrollment as a pupil within the
School System in accordance with section 22.1-3.1 of the Code of Virginia.
1.
What is your name?_______________________________________________________
2.
Have you been advised by an official of the Arlington County Public Schools, and do you
understand that you are required to answer the questions contained in this Affidavit as a
condition of your enrollment and admission of a pupil into the Arlington Public Schools
because of your inability to provide the School System with a certified copy of the
pupil’s birth record? _______________________________________________________
3.
Do you understand that giving false or otherwise untrue answers to any of the questions
in the Affidavit could result in a criminal charge of perjury being brought against
you?______________.
4.
Do you have legal custody imposed by a court order or have you been designated court-
appointed guardian for the pupil you desire to be enrolled?
________________________________________________________________________
What court entered such order and what type of case was it (i.e., custody hearing, etc.)?
________________________________________________________________________
5.
To the best of your knowledge has this pupil ever been reported to any law enforcement
agency as a missing child?__________________________________________________
If your response to the above question is yes, identify by name and address the law
enforcement agency and date of report.________________________________________
6.
What document (written) proof can be or is offered of the pupil’s identity and age?
(ATTACH COPIES) ______________________________________________________
_______________________________________________________________________
- Continued on the other side -
Ref. VA Code 22.1-3.1
APS 07-07227
SCR SY 2015-16 REG PKT: Affidavit form

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