3120P – Exhibit C
Page 1 of 3
Bellevue School District 5/1/2020
CHANGE OF ADDRESS AND UPDATED RESIDENCY VERIFICATION FORM
In order to enroll in school State law requires that a student reside within the District boundaries and
be able to prove residency or have been approved for an Interdistrict transfer.
PREVIOUS ADDRESS DATE OF MOVE
Parent/Guardian last name first name
PLEASE PRINT
Please list below the names of additional siblings living at this new address
who attend the Bellevue School District:
Student:
Last Name First Name School Date of Birth Grade
Student:
Last Name First Name School Date of Birth Grade
Student:
Last Name First Name School Date of Birth Grade
2) CELL HOME WORK PARENT PHONE 1) CELL HOME WORK
ZIP CODE STATE CITY
DATE OF BIRTH
WA
Submit this form with the required documents as directed below within five (5) school days of changing residence.
You must do this even if you have notified the school of the new address.
New address is within Bellevue School District (BSD) attendance boundaries
New address is outside Bellevue School District (BSD) attendance boundaries
If the new residence is outside BSD attendance boundaries and you would like your student to complete the school
year you must submit the following 2 documents:
1) BSD Interdistrict Transfer Application to studentplacement@bsd405.org
2) Choice Transfer Request to your resident school district
This form is submitted online through the OSPI parent portal. You will be directed to enter your email
address, an access code will be emailed to you that you will need to enter to begin.
If the new residence is within BSD attendance boundaries you are required to reestablish residency.
Please review the Residency Checklist and email your 2 required items with this form to SPResidency@bsd405.org.
If you are unable to provide two items, email at least 1 item with this form to SPResidency@bsd405.org.
Student Placement Residency will work with you to create a Residency Agreement that will give you extra time
(typically about 2 months) to collect the required documents.
Renters – please email the complete lease agreement signed by both parties
New Homeowners – please email the statutory warranty deed and settlement statement. These closing
documents are not accepted to establish residency but may be used to create a Residency Agreement.
If the new residence is in a different attendance area, to complete the school year or level you must submit a
Transfer Request or Request to Remain.
If your student is receiving services in a BSD centered program (Advanced Learning, Special Education), your
student's school assignment is program determined and you must contact the appropriate department to determine
if your move will affect your student's current school assignment.
New address is within BSD attendance boundaries, but in a different school attendance area
