Forms Portal
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Change of Address Form

Current Signature

Parent/Legal Guardian signature (use mouse to sign)

Name of Parent/Legal Guardian

STUDENT INFORMATION

Middle Initial

ACKNOWLEDGEMENT
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Relationship to Student

 Please verify your answers. After pressing SUBMIT FORM, if there are errors, they will be noted in red.

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The answer you give below will help the district determine what services you or your child(ren) may be able to receive under the  McKinney-Vento Act. Your answer will be kept confidential and will only be shared with those staff responsible for providing  services to the student and keeping track of how many students are identified as living in temporary housing. Students who are  protected under the McKinney-Vento Act may also be entitled to free transportation and other services.

Where is the student currently living? (Please select one ) 

(sometimes referred to as "doubled up")

Any change to a student’s home address requires that new proof of residency be provided to the district registrar. Acceptable  documentation includes, but is not limited to: closing document, deed, mortgage statement, signed residential lease, rental  agreement, current utility bill, recent property tax or school tax bill, DSS or SSI paperwork with your name and new address. This can be done in person or by using the "Document Attachment Form"  on the District website registration page.

ITHACA CITY SCHOOL DISTRICT

 

400 Lake Street • P.O. Box 549 • Ithaca, New York • 14851-0549

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ADDRESS and CONTACT INFORMATION
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Last Name
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First Name
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Grade
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School
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Student ID

OFFICE USE ONLY