Sample Proof Of Student Residence Template printable pdf download

Sample Proof Of Student Residence Template

PROOF OF STUDENT RESIDENCE

I do swear or affirm that:

1. My name is

. I am head of household at

(Name)

(Address)

(City)

(State)

(Zip)

2. Currently,

resides with me at the address listed above.

(Parent/guardian name)

3. The student(s),

, will be attending

(Children of parent/guardian)

school from the address listed above.

4. Head of household’s telephone number is (

)

The above information is true and correct to the best of my knowledge and belief.

Date:

(Signature of parent/legal guardian)

County of

(Signature of head of household)

State of

Subscribed and sworn to (or affirmed) this

day of

, 20

(Notary)

(Commission Expiration Date)

This notarized document must be accompanied by a copy of a utility bill from the last 30 days in the

head of household’s name (electricty, water, gas, cable, home phone, lease or mortgage agreement).

OFFICE OF STUDENT ADMISSIONS

1211 McGee Street – Kansas City, Mo. 64106 – (816) 418-7505

Rev. 08/12

An Equal Opportunity Employer

Sample Proof Of Student Residence Template