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 student must 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 person who knowingly enrolls or attempts to enroll in this School District on a tuition-free basis a student known by that
person to be a nonresident of the district is guilty of a Class C misdemeanor, except in very limited situations as defined in
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 a student
for the purpose of enabling that student to attend any school in that district without the payment of a nonresident tuition
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/Guardian Date
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
