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
__________________________________________, a student seeking to register in the
_________________________________, 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:
city, state, zip
Signature of Father Signature of Mother
Signature of Legal Guardian Day/Month/Year