Form 2230 - Proof of Residency

STUDENTS                                                                           Form 2230

Admission and Withdrawal

Proof of Residency

PROOF  OF  RESIDENCY

OR  THAT  REQUEST  FOR  WAIVER  HAS  BEEN  SUBMITTED

I herby certify as follows:

I, ________________________________________, am the parent/guardian of

                        Parent/Guardian

__________________________________________, a student seeking to register in the

                        Student

_________________________________, and am legally authorized to make educational

School District          decisions for the Student.

I further certify as follows:  (Check one category, and provide all additional information requested under the category checked.  WARNING:  Under Missouri Law, any person who knowingly submits false information with respect to the following questions, any subparts thereto, or the documents provided to support the responses to such questions, may be charged with and convicted of a Class A misdemeanor). 

The Student is legal resident of the District as established by the following:

I am a legal resident of the _____________________________________ School District.

I reside and am legally domiciled (have my permanent home) at the following address:

______________________________________

                              street

______________________________________

                        city, state, zip

________________________________              _________________________________                   

              Signature of Father                                                Signature of Mother

________________________________              _________________________________

       Signature of Legal Guardian                                               Day/Month/Year