Fillable Printable Proof Of Student Residence
Fillable Printable Proof Of Student Residence
Proof Of Student Residence
PROOF OF STUDENT RESIDENCE
I do swear or afrm that:
1. My name is
(Name)
. I a m h e a d o f h o u s e h o l d a t
(Address) (City)
(State) (Zip)
.
2. Currently,
(Parent/guardian name)
resides with me at the address listed above.
3. The student(s),
(Children of parent/guardian)
, will be attending
school from the address listed above.
4. Head of household’s telephone number is
( )
- .
The above information is true and correct to the best of my knowledge and belief.
Date:
(Signature of parent/legal guardian)
County of
(Signature of head of household)
State of
Subscribed and sworn to (or afrmed) this day of , 20 .
(Notary)
(Commission Expiration Date)
This notarized document must be accompanied by a copy of a utility bill from the last 30 days in the
head of household’s name (electricty, water, gas, cable, home phone, lease or mortgage agreement).
OFFICE OF STUDENT ADMISSIONS
1211 McGee Street – Kansas City, Mo. 64106 – (816) 418-7505
An Equal Opportunity EmployerRev. 08/12
