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): ___________________