60 Weston Street, Huntington Station, New York 11746
TEL: (p: (631) 812-3180

THIS FORM MUST BE COMPLETED BY THE PARENT OR GUARDIAN OR PERSON IN PARENTAL RELATIONSHIP.

Change of Address

Today's Date * +

Print First and Last Name of Person Completing Form: *

Your relationship to the student(s)? *

Please enter your email: 🛈

Please enter your phone number: *

Old Address: *

New Address: *

Please complete the information below so we know which student's are enrolled in the South Huntington UFSD.

Student 1:

Student's Last Name: *

Student's First Name: *

School Enrolled: * 🛈

Student 2:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Student 3:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Student 4:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Student 5:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Please upload your proof of residency below so that we can update your legal address.

Please select your residency status below: *

Copy of Mortgage Statement, Deed, or Tax Bill *

Copy of Signed Lease Agreement *

Affidavit of Tenant *

Affidavit of Landlord *

Affidavit of Family Member *

Proof for Family Member's Residency (Copy of Mortgage Statement, Deed, Tax Bill, or Lease Agreement showing they live in South Huntington UFSD) *

Proofs of residency include 3 of the following:

1) This month’s telephone bill in your name
2) This month’s cable bill in your name
3) This month’s bank statement in your name
4) This month’s PSEG bill in your name
5) Current Photo ID (Driver’s License)
6) Pay Stub
7) Income Tax Form
8) Utility or other bills
9) Voter registration documents
10) Official driver’s license, learner’s permit, or non-driver identification
11) State or government issued identification
12) Documents issued by federal, state or local agencies, such as the local social service agency or the Office of Refugee Resettlement
13) Evidence of custody of the child, including but not limited to judicial custody orders or guardianship papers

Proof of residency 1 *

Proof of residency 2 *

Proof of residency 3 *

Please sign your name below: *

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