DECLARATION OF RESIDENCY

Declaration of Residency is required if the Parent/Guardian does not rent or own the place where they live. Basically, they are living with another family/person.

At the time of appointment both the Parent/Guardian and the Person/Family with whom they are living must be present.

Following documents must be provided for Declaration of Residency:

From the Parent/Guardian:

1. Parent/Guardian’s photo ID.

2. Student’s Birth Certificate or passport.

3. Two pieces of current official business mail* (e.g., Housing Authority Voucher, Bank

Statement,Health Insurance document, Credit Card Statement etc.).

If the parent/guardian has this documentation with them OR they must bring the

documentation to the school within 30 school days.

From the Family/Person the student and parent/guardian is living with :

1. Photo ID of the person with whom the student and the parent is living.

Two (2) of the following documents must be in the name of the person on the Photo ID:

2. For a Renter - Current rental property contract, lease, or payment receipt. OR

For a Homeowner - Current property tax statement, current mortgage statement, or final close of escrow.

3. Utility start of service contract/confirmation of service, statement, or payment receipt.*

4. Pay Stub.*

5. Correspondence from a government agency.*

6. Voter registration.

(*Current documents within 30 days)

Rvsd. 3/19/15-jr

DATE            New Student   TIME            Continuing Student         SPECIALIST               Previous Student     Student ID Number  

FREMONT UNIFIED SCHOOL DISTRICT Office of Student Support Services 

CONTACT NUMBER               Information Sheet         

 

Today’s Date           Type of Referral              School               

Student #1’s Name             Date of Birth          Age       Grade     Ethnicity            Race            Language            SPECIAL ED:     No    Yes (ED / LH / RSP / SDC/ SLD/ Speech / Other ____________________________)   504 Plan:       No       Yes     

Was the student ever expelled?    No    Yes    If yes, when?                      Reason:                                

Was the student suspended last school year?    No    Yes  If yes, how many days & reason/s?          

Is student currently on probation?    No    Yes  If yes, name of Probation Officer                   

Student #2’s Name             Date of Birth          Age       Grade     Ethnicity            Race            Language            SPECIAL ED:     No    Yes (ED / LH / RSP / SDC/ SLD/ Speech / Other ____________________________)   504 Plan:       No       Yes     

Was the student ever expelled?    No    Yes    If yes, when?                      Reason:                                

Was the student suspended last school year?    No    Yes  If yes, how many days & reason/s?          

Is student currently on probation?    No    Yes  If yes, name of Probation Officer                  

Parent/Guardian Information  

Mother’s Name        Date of Birth      Address:      

Stepmother’s Name        Date of Birth      Address:      

Father’s Name        Date of Birth      Address:      

Stepfather’s Name        Date of Birth      Address:      

Name & Relationship (uncle, friend, etc.) of person/s with whom Family is living:   

Other Person        Relationship                

Address        Phone                   

Background Information (i.e.  new/continuing/previous student in Fremont USD, new to country, moved from another state, foster youth, etc.)  

                    

                    

                    

                    

TWO (2) PROOFS OR RESIDENCY ARE REQUIRED (California Education Code 48204.1):  Evidence of residency (BP 5111.1) may be established by documentation showing the name and address of the parent/guardian within the District,  including, but not limited to, two (2) of any of the following: 

Property tax payment receipt or mortgage statement;  

Rental property contract, lease, or payment receipt;  

Utility service contract, statement, or payment receipt; 

Pay stub; 

Voter registration; 

Correspondence from a government agency; 

Declaration of Residency executed by the student's parent/guardian.  

   

ALL DOCUMENTS MUST BE CURRENT (WITHIN 30 DAYS) 

PROOF #1 (For staff use only)

PROOF #2 (For staff use only)