SHARED HOUSING PROOF OF RESIDENCE Family Living With Another Family

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1 SHARED HOUSING PROOF OF RESIDENCE Family Living With Another Family 1. The person who owns/rents the property must sign the Proof of Residency Affidavit verifying that the parent/guardian and the student are residing with them at the present time. The Affidavit must be notarized. If the residence is an apartment complex, a letter from the property manager/owner establishing permission to reside there may also be required. 2. The person who owns/rents the property must provide at least one (1) address verification document that establishes their connection to the property. The verification should be in the form of a contract, lease, utility bill, water bill, cable bill, phone bill, or other service bill. 3. The parent/legal guardian will be required to provide two (2) address verification documents for the stated address. At least one document must be: 1) Paycheck Stub 2) W-2 Statement 3) State/Federal Supported Services (DSS, SCDMV, SC Dept. of Employment & Workforce, Social Security Administration, Federal or SC Student Loan, SC Child Support Enforcement, etc.). You may use as a second address verification: 1) Car Registration or 2) Bank Statement Parents/guardians may also be required to provide proof that they are no longer residing at their previous address. This proof can be in the form of a letter from the previous landlord (on letterhead), a cancellation of service notice, or a notarized statement. 4. A completed Application Form and Photo ID are to be submitted with the Proof of Residency Affidavit. Please Note: 1. Once the two address verification documents are provided, an assignment for the term of one school year will be made. The assignment will expire the last day of the current school year. If the parent/legal guardian has recently moved and does not have the two specified address verification documents, a 10-day temporary assignment can be made. Schools have the authority to withdraw students after the temporary assignment expires if the necessary documentation is not received. The Proof of Residence process must be completed and renewed annually. 2. If the temporary Proof of Residence requirements are not completed by the end of the school year, the parent/guardian will not be issued a temporary Proof of Residence assignment for the next school term if they are residing at the same address. The parent/guardian must have all required documents to establish Proof of Residence in cases as such. 3. FEDERAL LAWS PROHIBIT THE USE OF GOVERNMENT UNITS (SECTION 8) AS SHARED HOUSING. Parent/guardian and student must be listed on the lease for government housing. Family Recently Moved 1. Families that have recently moved and are unable to provide a lease and utility statement (verification) to the school must obtain assignment permission. A family that has a copy of their contract/lease and order forms for electrical service, telephone service, water service, or cable service should provide the documents directly to the school. 2. The Registrar s Office will issue temporary assignment letters to families who are in transition to include but not limited to military relocations and real estate closings. Verification of the transition must be provided in the form of a copy of the military orders, a letter from the realtor indicating a closing date, or similar document(s). 3. A completed Registrar s Office Application Form is to be submitted with the Proof of Residence Form. Please Note: Temporary assignments will only cover the time period needed to complete relocation and/or to obtain two address verification documents. At that time, the assignment will be complete for one school year. If currently residing outside of Richland One, out of district tuition fees will be assessed pending relocation to Richland One.

2 REGISTRAR S OFFICE APPLICATION FORM Richland County School District One Parent(s)/Guardian(s) Name Street Address Apt. /Lot City Zip Home Phone Work Phone TRANSFER BASIS (Choose one only): Child Care Administrative (Severe Hardship) Employee Option (Worksite: ) Programmatic (Program: ) JFABC (To Complete School Year Only) No Documented Hardship No Space Available Basis Not Applicable BASIS FOR REQUEST ASSIGNMENT BASIS: Shared Housing/Proof of Residence Court Order Educational Rights Out of District Acceptance Out of District Release Check if Applicable STUDENT S NAME(S) Sex Race AAP Sp. Ed. Grade Level Previous School Information Is this a renewal? Yes No Last application date? Have you submitted any paperwork for the current school year before now? Yes No Are any student(s) above suspended or expelled? Yes No If yes, please name Please Read the Following Carefully and Initial Each Line Parents/guardians must provide transportation for approved transfer requests. Transfers made without an actual change of residence by the parent/legal guardian may interrupt a student s athletic eligibility in grades 7-12 for one calendar year. Please consult district Athletic Director. Transfers may be revoked for reasons including but not limited to repeated tardiness and/or irregular attendance, violation of discipline code, submission of incorrect information, and employee separation from the district. All applications must have the appropriate accompanying documentation and current proof of residence. I have read and understand the directions for applying for the student transfer. I agree to abide by the policies of Richland County School District One. I testify that all of the information on this form and the documentation submitted with my request are true and accurate. I understand that failure to comply with these conditions, or falsification of any portion of this application may result in the denial or revocation of my request. Parent/Guardian Signature: Date: DO NOT WRITE BELOW THIS LINE! FOR OFFICE USE ONLY Notes: School(s) Zoned for Residence CPU# TMS# Elementary Middle High Requested Zone(s) CPU# TMS# Elementary Middle Request Granted High Request Denied Date Temporary/Expires Permanent Signature of Staff Member Processing Request Registrar s Office 1310 Lyon Street Columbia, SC Phone: (803) Fax: (803) Website:

3 SHARED HOUSING - RESIDENCY VERIFICATION/LEGAL RESIDENCE ASSESSMENT STATE OF SOUTH CAROLINA AFFIDAVIT OF A STUDENT S DOMICILE COUNTY OF RICHLAND PENALTIES FOR PROVIDING FALSE INFORMATION This affidavit is made under penalty of perjury. I acknowledge that if I provide false information about where a student lives, I can be prosecuted for perjury. In addition, S.C. Code states (emphasis added): (D) If it is found that information contained in the affidavit is false, the child must be removed from the school after notice and an opportunity to appeal the removal pursuant to the appropriate district grievance policy. (E) If it is found that a person willfully and knowingly has provided false information in the affidavit to enroll a child in a school district for which the child is not eligible, the maker of the false affidavit is guilty of a misdemeanor and, upon conviction, must be fined an amount not to exceed two hundred dollars ($200.00) or imprisoned for not more than 30 days and must also be required to pay to the school district an amount equal to the cost to the district of educating the child during the period of enrollment. Repayment does not include funds paid by the state. ************************************************************************************************** 1. I am PARENT/GUARDIAN and it is my signature that appears below. (Parent Name) I am PARENT/GUARDIAN and it is my signature that appears below. (Parent Name) 2. I make this affidavit based upon my own personal knowledge, and if called upon, I believe I would be deemed competent to testify to the facts and beliefs set forth in this affidavit. 3. I am aware of the penalties to myself and to the student for providing false information in this affidavit. 4. I am an adult responsible for the care and well-being of the following student(s): Name of Student Grade Level Date of Birth 5. As of the date I have signed this affidavit that student for whom I am responsible actually lives at the following address: Address City Zip Code Page 1 of 2 Note: This form will NOT be accepted if it is altered from its original content and/or format.

4 6. Under penalty of perjury, I certify that, as primary caregiver of my applicant child: (a) the residence which is the subject of this application is my legal residence and my domicile, the place where I and the student actually live at the time of this application and that I do not claim to be a legal resident of a jurisdiction other than Richland County, South Carolina for any other purposes; and (b) that neither I nor any other member of my household (that is: the owner-occupant s or lessor-occupant s spouse, except when that spouse is legally separated from the owner/lessor occupant and any child of the owner/lessor-occupant claimed or eligible to be claimed as a dependent on the owner/lessor-occupant s federal income tax return) is residing in or occupying any other residence which I, or any member of my immediate family, has qualified for legal residency. 7. I acknowledge that if a challenge is made to the truthfulness of information I provide that additional information may be required of me. 8. Further, affiant sayeth not, Parent Signature Printed name Phone Number Parent Signature Printed name Phone Number SWORN to and subscribed before me this day of, 20 Notary Public for South Carolina My commission expires: ************************************************************************************************** HOMEOWNER OR LESSOR: I am the head of household/lessor of (Address) (City) (Zip code) and the above student(s) and parent(s)/guardian(s) reside with me. Attached is a copy of our lease or property tax bill or utility bills. Homeowner/Lessor Signature Printed name Phone Number SWORN to and subscribed before me this day of, 20 Notary Public for South Carolina My commission expires: Page 2 of 2 Note: This form will NOT be accepted if it is altered from its original content and/or format.

5 Richland County School District One General Consent Form I hereby authorize Richland County School District One, to verify my address for the purpose of enrolling the child(ren) or so they may remain enrolled. I further authorize the following specific establishments, but do not limit the authorization to release information from these companies: SCE&G, Mid-Carolina Electric, City of Columbia, Bellsouth, AT&T, Time Warner Cable, Fairfield Electric, Tri-County Electric, etc. The information obtained by Richland School District One is only to be used by Richland School District One for verification purposes. A photographic or FAX copy of this authorization may be deemed to be equivalent to the original and may be used as a duplicate original. Signature, Home Owner/Renter Date Signature of Parent/Legal Guardian Date

6 PROOF OF RESIDENCE Additional Information Parent/Guardian Previous Address: City: State: Zip: Parent/Guardian Previous Telephone Number: Student Name Previous School Previous School Location

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