Fillable Printable Columbia Community Unit School District
Fillable Printable Columbia Community Unit School District
Columbia Community Unit School District
COLUMBIA COMMUNITY UNIT SCHOOL DISTRICT #4
PROOF OF RESIDENCE
Name of Student: ______________________________________Grade_________
Date of Birth: ________________________________________________________
NEW STUDENTS:
A parent/guardian* seeking to enroll a new student in Columbia Community Unit School District #4 must present the following
documentation:
1.A certified or registered birth certificate for the student.
2.Valid IL driver’s license with current address of parent registering the student.
3.Evidence of proof of residency presented (one from each category):
Category I:Category II:
most recent real estate tax bill current monthly utility bill
mortgage papers (gas, electric, water, trash, sewer, cable TV)
sales agreement public aid card
current signed and updated lease home/apartment insurance papers
letter of residence from landlord in lieu of lease
RE-ENROLLED STUDENTS:
A parent/guardian* re-enrolling a student in the Columbia Community Unit School District #4 must present one document
from either Category I or Category II listed above.
Anyone with a Custody Order seeking to enroll or re-enroll a studentmust present a copy of said Order, Agreement,
Judgment or Decree that awards or gives custody of the student to any person (including divorce decrees awarding custody
to one or both parents.)
I cannot provide the required evidence for the following reason(s):
________________________________________________________________________________
________________________________________________________________________________
I will provide the required evidence of my residency by ___________________.
(date)
A personwhoknowinglyenrollsorattemptstoenrollinthisSchoolDistrictonatuition-freebasisastudentknownbythat
persontobe anonresidentofthedistrictisguiltyof aClassCmisdemeanor,exceptinverylimitedsituations as definedin
State law (105 ILCS 5/10-20.12b(e).
A person who knowingly or willfully presents to the School District any false information regarding the residency of astudent
forthepurposeofenablingthatstudenttoattendanyschoolinthatdistrictwithoutthepaymentofanonresidenttuition
charge is guilty of a Class C misdemeanor (105 ILCS 5/10-20.12b(f).
I certify that I understand the residency requirements.
_______________________________________________________
Signature of Parent/GuardianDate
Relationship:__________________________________________________________________
Address of Parent/Guardian:_____________________________________________________
Telephone: ____________________________
*A non-parent seeking to enroll a student OR parent/guardian living with a District resident seeking to
enroll a student must use the Affidavit Registration Process.
NEW STUDENT
RE-ENROLL
Revised 6/21/12
