GWINNETT COUNTY PUBLIC SCHOOLS
NOTARIZED RESIDENCY AFFIDAVIT
Non-Parental Affidavit of Residence
DOE Rule 160-5-1-.28
GCPS Procedure JBA
This form shall be completed for students seeking enrollment in Gwinnett County Public
Schools, who live with their parents or legal guardians, but reside in the home of another
adult. Residency Affidavits should be resubmitted annually at least 2 weeks prior to the
beginning of each school year.
This form shall be completed by the adult with whom the student and parent/guardian are
I, the undersigned, am over eighteen (18) years of age and competent to testify to the facts
and matters set forth herein.
The student whose legal name is ______________________________________________
and whose birth date is_____/_____/_____ lives with me at the following address:
Apartment Manager/Landlord Witness Signature
1. Reason the student is living with above named adult (check one or as many as apply)
A. _____ The loss or inhabitability of the student’s home as a result of a natural disaster.
B. _____ The parent or guardian is unable to provide care and supervision of the
student because he or she is serving in the military.
C. _____ Other circumstances (explain below):