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School Residency Affidavit Template
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School Residency Affidavit Template
This School Residency Affidavit (the “Affidavit”) is made on [Date] by:
School/District (Optional): [School Name / District]
Student: [Student Full Name], DOB: [DOB], grade (optional): [__]
Residence Address Being Verified: [Street Address, City, State, ZIP]
Move-In Date (If Known): [Date]
1. Affiant Information (Who Is Signing)
1.1 Parent/Guardian Affiant: [Full Name], relationship to student: ☐ parent ☐ legal guardian ☐ other: []
Address (if different): [] | Phone/email: [__]
1.2 Host Household Affiant (If Student Lives With Another Adult):
[Full Name], relationship to student: ☐ grandparent ☐ relative ☐ caregiver ☐ family friend ☐ other: []
Phone/email: []
2. Residency Statement
2.1 I declare that the student named above resides at the Residence Address listed and that this address is the student’s:
☐ primary residence ☐ temporary residence (explain): [__].
2.2 The student has lived at this address since: [Move-In Date].
3. Household and Custody (Optional)
3.1 Adults residing in the household (optional): [Names].
3.2 If student lives with host household: reason (optional): ☐ family hardship ☐ caregiver arrangement ☐ other: [__].
3.3 Custody/guardianship documents (if applicable): ☐ attached ☐ not applicable ☐ pending.
4. Supporting Documents (Attach as Available)
4.1 ☐ Lease/mortgage statement (host or parent/guardian)
4.2 ☐ Utility bill (gas/electric/water/internet)
4.3 ☐ Government mail showing address
4.4 ☐ Photo ID for affiant(s)
4.5 ☐ School form(s) required by district
4.6 ☐ Other: [List]
5. Statement Under Oath
5.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.
Signatures
Parent/Guardian Affiant: [Full Name]
Date: [Date]
Signature: ___________________________
Host Household Affiant (If Applicable): [Full Name]
Date: [Date]
Signature: ___________________________
Witnesses (If Required)
Witness Name: [Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (If Required)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Parent/Guardian Affiant Name] (and [Host Household Affiant Name], if applicable), known to me (or satisfactorily proven) to be the person(s) whose name(s) are subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________
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School Residency Affidavit Template
SCHOOL RESIDENCY AFFIDAVIT TEMPLATE FAQ
What is a school residency affidavit?
A School Residency Affidavit is a sworn statement used to confirm a student’s residence within a school district or attendance zone. Schools may require it when a family lacks typical proofs (like a lease or utility bill) or when a student lives with someone other than a parent.
Who signs it?
Often a parent or legal guardian signs. If the student lives with another adult (relative or caregiver), that adult may also sign. This template includes both parent/guardian and host household options.
What should be included?
Include the student’s name and date of birth, the residence address, who lives at the address, the relationship to the student, and an affirmation that the information is true. This template also includes a checklist for common supporting documents.
Do you need notarization?
Many schools require notarization. This template includes notarization and an optional witness section.
Does this replace other enrollment documents?
No. Schools may still require additional enrollment forms, immunization records, and custody/guardianship documents. This affidavit focuses only on residency verification.
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