Form 1 - Dc Residency Verification Form Page 2

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SY 2017-18 |Updated 3/21/17
List of Acceptable Supporting Documentation Checklist
Section 1 (One is needed from this list to verify residency.)
o
Pay stub: Issued within the forty-five (45) day-window immediately preceding the school’s review of residency documentation, that contains
the name of person enrolling the student or the name of the adult student, shows his/her current DC home address, and shows withholding
of DC personal income tax for the current tax year.
o
Unexpired official documentation of financial assistance from the Government of the District of Columbia: Issued to the person enrolling the
student or the adult student within the past twelve (12) months and be current at the time presented to the school, including, but not
limited to, Temporary Assistance for Needy Families (TANF), Medicaid, the State Child Health Insurance Program (SCHIP), Supplemental
Security Income, housing assistance or other programs.
o
Certified copy of Form D40: Certified by the DC Office of Tax and Revenue, with the name of person enrolling the student or the name of the
adult student as evidence of payment of DC taxes for the current or most recent tax year.
o
Military housing orders: Showing the name of the person enrolling the student or the name of the adult student, and their residency or
home address in DC, including but not limited to a DEERS statement or other official communication on military letterhead.
o
Embassy letter: Issued within the past twelve (12) months showing the name of the person enrolling the student or the name of the adult
student, indicating that the caregiver and the dependent student or the adult student currently live on embassy property in the District of
Columbia or will reside on DC property confirmed by the embassy during the relevant school year, and an official embassy seal.
Section 2 (Two are needed from this list to verify residency. The address and name on each of the items must be the same.)
o
Unexpired DC motor vehicle registration showing the name of the person enrolling the student or the name of the adult student and his/her
current DC home address.
o
Unexpired lease or rental agreement with proof of payment of rent , in the name of the person enrolling the student or the name of the adult
student, for a period within two (2) months immediately preceding the school’s review of residency documentation, for the current DC
address at which the student actually resides.
o
Unexpired DC motor vehicle operator’s permit or official government issued non-driver identification in the name of the person enrolling the
student or the name of the adult student showing his/her current DC home address.
o
Utility bill ( only gas, electric, and water bills are acceptable ) with proof of payment of a bill , from a period within the two (2) months
immediately preceding the school’s review of residency documentation, listing the name of the person enrolling the student or the name of
the adult student and his/her current DC home address,.
Section 3 (If one of these applies, no signature is required in Part B.)
o
Homeless: There is evidence that the student is homeless and the school’s homeless liaison has provided the appropriate homeless
documentation.
o
Ward of the District of Columbia: Proof that child is a ward of the District of Columbia, in the form of a court order or official documentation
from DC Child and Family Services Agency.
Penalty for False Information:
Any person, including any District of Columbia public school or public charter school official, who knowingly supplies false information to a public official in
connection with student residency verification shall be subject to charges of tuition retroactively, and payment of a fine of not more than $2,000 or
imprisonment for not more than 90 days, but not both fine and imprisonment, pursuant to the District of Columbia Nonresident Tuition Act, approved
September 8, 1960 and amended by the District of Columbia Public Schools and Public Charter School Student Residency Fraud Prevention Amendment Act of
2012 (D.C. Code §38-312). The case of any such person may be referred by the Office of the State Superintendent of Education to the Office of the Attorney
General.

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