Residence Assessment

Academic School Year

Enrolling Parent/Guardian/Caregiver

Address

City

State

ZIP

Contact Number

Relationship to Student

Enrolling Parent/Guardian/Caregiver Email

Legal Guardian

Address

City

State

Zip

Contact Number

I am seeking to enroll the above named student for the following reason(s): (Check ALL that apply)

Student's parent/legal guardian is incarcerated/in jail

Student's parent/legal guardian is in military on deployment

Student was placed with me by an agency (DHR, DYS, etc)

I have petitioned the court for legal custody

I am a student who is NOT living with a legal parent/guardian

I am living in a temporary housing situation

Other
Other Description

Please explain the current situation (living, custody, etc.):