Columbus City Schools
[Pages:2]Columbus City Schools Address Change Form
Students/Siblings living at the Same Address and Attending School (Add any additional students on a separate sheet of paper)
1st Student's Legal Name: (Please Print)__________________________________________________________________________
Last
Suffix (if any)
First
Middle
Student Number: ____________________
Birth Date: (MM/DD/YYYY) _______________ Grade: ____________
Prior School: ______________________________________
New School: ______________________________________
2nd Student's Legal Name: (Please Print)_________________________________________________________________________
Last
Suffix (if any)
First
Middle
Student Number: ____________________
Birth Date: (MM/DD/YYYY) _______________ Grade: ____________
Prior School: ______________________________________
New School: ______________________________________
3rd Student's Legal Name: (Please Print)__________________________________________________________________________
Last
Suffix (if any)
First
Middle
Student Number: ____________________
Birth Date: (MM/DD/YYYY) _______________ Grade: ____________
Prior School: ______________________________________
New School: ______________________________________
4th Student's Legal Name: (Please Print)__________________________________________________________________________
Last
Suffix (if any)
First
Middle
Student Number: ____________________
Birth Date: (MM/DD/YYYY) _______________ Grade: ____________
Prior School: ______________________________________
New School: ______________________________________
Primary/Residential Household (This is the address where the student(s) reside(s).)
Home Address: ______________________________________________________________________________________________
House #
Street Name
Apt #
City
State
Zip Code
Mailing Address: _____________________________________________________________________________________________
House #
Street Name
Apt #
City
State
Zip Code
Home Phone: ____________________________
Unlisted: Yes No
Cell Phone: ____________________________
Unlisted: Yes No
Proof of address type: Builder's Statement Emancipation Employment Records Government Office
Landlord's Statement Lease
Recent Utility Bill Other _______________
Dwelling type: Apartment House Other ____________________________
Revised 11/21/2017
Page 1 of 2
Primary/Residential Parent or Guardian (This is the primary/residential parent/guardian for the student(s) listed.)
Name: (Please Print)_________________________________________________________________ Gender: Male Female
Last
First
Middle
Employer: ___________________________ Work Phone: ________________________________ Has Custody?: Yes No
Cell Phone: ___________________________ Email Address: ______________________________
Parent Legal Guardian (by court) Stepparent Foster Parent Other: (specify) ______________
Types of communications to receive from the school
Parent Portal
Emails
Parent, Guardian, or Authorized Adult (This is the second parent/guardian or authorized adult)
Mailings
Name: (Please Print)_________________________________________________________________ Gender: Male Female
Last
First
Middle
Employer: ___________________________ Work Phone: ________________________________ Has Custody?: Yes No
Cell Phone: ___________________________ Email Address: ______________________________
Parent Legal Guardian (by court) Stepparent Foster Parent Other: (specify) ______________
Types of communications to receive from the school
Parent Portal
Parent Portal
Parent Portal
Secondary Household (This section should be completed if both parents DO NOT live in the Primary Household.)
Home Address: ______________________________________________________________________________________________
House #
Street Name
Apt #
City
St ate
Zip Code
Mailing Address: _____________________________________________________________________________________________
House #
Street Name
Apt #
City
State
Zip Code
Home Phone: ____________________________
Unlisted: Yes No
Cell Phone: ____________________________
Unlisted: Yes No
Name (Please Print)
Emergency Relationship Priority
1
Home Phone
Work Phone
Cell Phone
2
3
Verification of Information
Checklist/Office Use Only
By signing, I verify that all the information provided is true and verifiable to the best of my knowledge.
Parent/Legal Guardian Name (Printed): ___________________________________________
Proof of Residency Parent/Guardian ID Custody Papers (If
Applicable.)
Signature: ___________________________________________ Date: _________________
Revised 11/21/2017
Page 2 of 2
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