Co Resident Form - Cherry Creek School District
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1District Admissions – East
District Admissions – West
5416 S Riviera Way
9150 E. Union Avenue
Centennial, CO 80015
Greenwood Village, CO 80111
720-886-7480
720-554-4550
Co-Resident Registration
This form must be completely filled out and notarized prior to approval **Attached documents must be included.
Resident Information:
Date:__________________________
Name: _______________________________________________________________________________
Address: ___________________________________________, ____________________, ____________
( Number & Street)
(City)
(Zip Code)
Home Phone Number: _______________________________
Children Attending CCSD:
Yes
No
Residence is:
Owned
Rented / Leased
**Proof for Residency Attached:
Current Gas or Electric Bill
Current Signed Lease or Deed
( new lease agreement or deed must be within the last two months)
Co-Resident Information:
Parent/Guardian Name: _______________________________________________________________
Student Name(s): _______________________, ______________________, ______________________
Move-in Date: _______________________Expected Move-out Date: ___________________________
Reason for Co-Residency: ______________________________________________________________
Has this student(s) been denied as a Non-Resident or transfer student?
Yes
No
**Proof of Residency to address for Co-Resident:
Current Business mail received to this address
US Mail forward confirmation
New Colorado drivers’ license
Other ___________________
Under penalty of perjury, I affirm that all information given above is true and correct. I further understand and
agree that, if it is later determined that this family is not a legal resident of Cherry Creek School District #5, such
students will be withdrawn immediately from Cherry Creek Schools. I further agree to pay Cherry Creek Schools
any and all applicable tuition charges that may be due, together with the cost of collection thereof, including
reasonable attorney’s fees. A person commits perjury in the second degree if, with an intent to mislead a public
servant in the performance of his duty.
Colorado Revised Statutes, Sec l 18-8-503, 108-1-106
______________________________________
________________________________________
(Resident Signature)
(Co-Resident Signature)
State of Colorado
County of __________________________________
The foregoing instrument was acknowledged before me this (date) _________________________
by ________________________________________and ______________________________________.
(Name of Resident)
(Name of Co-Resident)
________________________________________
(Notary’s Official Signature)
Notary Seal
My Commission Expires: ___________________
For District Admissions Use Only:
Photo identifications and signatures of Resident and Co-Resident were verified by ____________.
Revised 10/12
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