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Adult applicants attest that they are at least 18, provide proof of residency for a specified school district, and have assumed responsibility for a pupil. The affidavit also states the pupil receives a fixed night-time abode for reasons other than program access, and clarifies when the form is not required. It warns that knowingly providing false information or improper enrollment is a Class C misdemeanor.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/affidavit-of-enrollment-and-residency/534829/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/affidavit-of-enrollment-and-residency/534829.png","ImageObject",300,407,{"name":92,"@type":93},"Mia  ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-10-10",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who can use this affidavit form?","Question",{"text":112,"@type":113},"An adult who has assumed responsibility for a pupil and provides the pupil with a fixed nighttime abode for reasons other than access to the school district’s educational programs. It should not be used for natural/adoptive parents, court-ordered custody/guardianship situations, or when receiving public aid for the pupil.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What information must the adult provide?",{"text":117,"@type":113},"The adult must list name and address, specify the school district, confirm at least 18 years of age, provide proof of residency, and state they exercise responsibility for the pupil and provide a fixed nighttime abode.",{"name":119,"@type":110,"acceptedAnswer":120},"What are the consequences of false statements or improper enrollment?",{"text":121,"@type":113},"Knowingly or willfully providing false information about a pupil’s residency to enable enrollment without nonresident tuition is a Class C misdemeanor. Knowingly enrolling or attempting to enroll a nonresident pupil without a lawful right to attend is also a Class C misdemeanor.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},534829,1792211558,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81,"preview_page_count":4},687207024478,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Use your \"Mouse\" or \"Tab\" key to move through the fields and check boxes. After completing last field, save document to hard drive to make future updates or click Print button.   \n100 North First Street  \nAFFIDAVIT OF ENROLLMENT AND RESIDENCY  \nSpringfield, Illinois 62777-0001  \nROE/ISC DEPARTMENT  \nThis affidavit form may be used if you are an adult who has assumed responsibility for a pupil and provide the pupil with a fixed, nighttime abode, for reasons other than access to the educational programs of the school district. This form should not be used, however, if you are the natural or adoptive parent of the pupil, have been granted court-ordered custody or guardianship, or are receiving public aid on behalf of the pupil. For these situations, you are only required to provide documentation (such as a birth certificate or court order), without the need of an affidavit like this one. This form is also not required for pupils who are sharing the housing of others due to lack of housing, economic hardship, or similar reason, or are otherwise homeless as defined in state and federal law. If you have any questions about residency, please contact the Illinois State Board of Education’s ROE/ISC Department at (217) 785-9998.  \nI,   , reside at  ,(Name of Adult) (Address)  \nwhich is located within the boundaries of   \n(School District)  \nProvide the appropriate information and check each of the following:  \nI am at least 18 years of age.  \nI have provided proof in the form(s) of    \n(Proof of Residency)  \nthat I am a resident of    \n(School District)  \nI have assumed and exercise responsibility for    \n(Name of Pupil)  \nI provide a fixed, night-time abode for    \n(Name of Pupil)  \n  is not living with me for the purpose of having access to the educational programs (Name of Pupil) of the school district.  \nI understand that knowingly or willfully providing false information to a school district regarding the residency of a pupil for the purpose of enabling that pupil to attend any school in that district without the payment of nonresident tuition is a Class C misdemeanor.  \nI understand that knowingly enrolling or attempting to enroll a pupil in the school of a school district of a tuition free basis when I know that pupil to be nonresident of the school district, unless the nonresident pupil has a lawful right to attend, is a Class C misdemeanor.  \nDate Signature of Adult Adult (Print Name)  \n_____________________________ __________________________________________ ________________________________________  \nDate School District Employee (Signature) School District Employee (Print Name)","cbCaiiYufOrJCG0H","https://ap.wps.com/l/cbCaiiYufOrJCG0H","pdf",265937,"English","# AFFIDAVIT OF ENROLLMENT AND RESIDENCY\n## Eligibility and when the form is required\n## Proof of residency and responsibility statements\n## Certifications, signature, and penalties","[{\"question\":\"Who can use this affidavit form?\",\"answer\":\"An adult who has assumed responsibility for a pupil and provides the pupil with a fixed nighttime abode for reasons other than access to the school district’s educational programs. It should not be used for natural/adoptive parents, court-ordered custody/guardianship situations, or when receiving public aid for the pupil.\"},{\"question\":\"What information must the adult provide?\",\"answer\":\"The adult must list name and address, specify the school district, confirm at least 18 years of age, provide proof of residency, and state they exercise responsibility for the pupil and provide a fixed nighttime abode.\"},{\"question\":\"What are the consequences of false statements or improper enrollment?\",\"answer\":\"Knowingly or willfully providing false information about a pupil’s residency to enable enrollment without nonresident tuition is a Class C misdemeanor. Knowingly enrolling or attempting to enroll a nonresident pupil without a lawful right to attend is also a Class C misdemeanor.\"}]","AFFIDAVIT OF ENROLLMENT AND RESIDENCY | PDF",1791599136]