Charles County Public Schools

Charles County Public Schools

VERIFICATION OF DOMICILE

I do hereby certify that I am domiciled with my child on a full-time basis at

(address)

which is the residence of

STUDENT DOB GRADE

Charles County School Student Will Attend Parent Contact Phone

Work Phone

Student’s Previous Home Address Previous Telephone Number

School Student Last Attended

Signature, Parent(s)/Legal Guardian Print Name Telephone Number

Please note: An investigation including a review of public databases, may be made to verify information. Unannounced home visits may occur.

The above named student will be enrolled in Charles County Public Schools as long as the student and parent(s)/legal guardian(s) are domiciled at the above address. If a change in domicile occurs, the parent(s)/legal guardian(s) must notify the school immediately. If it is determined that false information was provided, the parent(s)/legal guardian(s) whose signature appears below may be liable for assessed tuition, and both the parent(s)/legal guardian(s) and the homeowner(s)/lease holder(s) may be referred to the Office of the State’s Attorney for investigation and possible prosecution for theft of services.

My signature below indicates that I have reviewed the domicile requirements of Charles County Public Schools found in Superintendent’s Rule 5122.1 that appear on the reverse side of this form.

Signature of Resident (Owner/Leaseholder) Signature of Parent(s)/Guardian(s) of Student

Print Name Print Name

I hereby certify that on this ___day of , I hereby certify that on this ___day of ______,

20__, the above named, , 20 ___, the above named, ______,

personally appeared before me and made oath in personally appeared before me and made oath in

due form of the law that the foregoing facts are due form of the law that the foregoing facts are

true and correct to the best of his/her knowledge, true and correct to the best of his/her knowledge,

information, and belief, under penalty of perjury. information, and belief, under penalty of perjury.

Notary Public Notary Public

Print Name Print Name

My Commission Expires My Commission Expires

Approved: Date:

5122.1 Rule Number 5122.1

Proof of Domicile

When registering their children in Charles County Public Schools, parents or guardians will be required to show two proofs of domicile. Examples of acceptable proofs of domicile are:

Ø  Deed

Ø  Current verifiable lease or rental agreement

Ø  Mortgage Statement/Bill or Settlement Papers (with appropriate signatures)

Ø  Current utility bill (Complete bill with name and address)

Ø  Verification of Domicile form accompanied by two acceptable proofs of domicile for the owner/lessee of the property

Ø  Property tax bill for domicile (not assessment)

Ø  Current pay check with name and address

Ø  Current government-issued documents that include name, date, and home address (such as documentation of benefits from Social Security Administration)

Ø  Current court documents

Ø  Signed verification by a pupil personnel worker

·  If a family is living in the domicile of a friend or relative, the friend or relative must document their domicile through the department of student services through a Verification of Domicile form.

·  Families who are building or purchasing a home and will be moving into this home within the first marking period of the school year may enroll their children in Charles County Public Schools by special permission through the department of student services. The family will notify the school when they move into the new home in the county by providing documentation of their domicile.

·  Families living outside the county may request to pay tuition to have their children attend Charles County Public Schools. The families must receive permission through the department of student services, sign a tuition contract, and provide two supporting documents as proof of their out-of-county domicile. Tuition rates are based on the family’s out-of-county status, as well as any special support services required by the student. Tuition contracts may not be accepted in schools at or above their enrollment capacity.

·  Families in Charles County who are caring for children from other counties or states must have proof of court-appointed guardianship/custody prior to enrolling the children in Charles County Public Schools. Some families are exempted from this rule by state and federal laws such as the McKinney-Vento Act. Families of students in the fifth and eighth grades will be required to provide two current proofs of domicile prior to entering the sixth and ninth grades.