Fillable City School District of Albany Change of Address (City of Oakland)

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City School District of Albany Change of Address (City of Oakland)

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The City School District of Albany Change of Address (City of Oakland) form is 2 pages long and contains:

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File type: PDF

U.S.A. forms for City of Oakland

BROWSE CITY OF OAKLAND (CA) FORMS

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City School District of Albany
Change of Address
For Central Registration Use only
Registration Date: _____________________ Initials: ____________
Student ID #: _________________________ Grade: ____________
School: ___________________________________________________
R/A: YES/ NO S.E.: YES/ NO M.V.: YES/NO E.N.L.: YES/NO
Student’s Name: ______________________________________________________________________________
Last First Middle
Gender: Male / Female Date of Birth: _______________________________
MM/DD/YYYY
Student’s Home Phone Number: ____________________________
Student’s PREVIOUS Home Address: _____________________________________________________________
# Street Apt #
_____________________________________________________________
City State Zip Code
Student’s NEW Home Address: _____________________________________________________________
# Street Apt #
__________________________________________________________________________
City State Zip Code
Does Your Child Receive Any Special Education Services? YES / NO
With Whom Does The Student Live? Both Parents____ Mother ____ Father ____ Guardian____ Other____
Parent/Guardian Name: ______________________________________ Relationship: _______________________
Home Phone: ____________________________
Work Phone: _____________________________ Cell Phone: ____________________________
PREVIOUS Home Address: _______________________________________________________________________
# Street Apt # City State Zip Code
NEW Home Address: ____________________________________________________________________________
# Street Apt # City State Zip Code
Parent/Guardian Name: ______________________________________ Relationship: _______________________
Home Phone: ____________________________
Work Phone: _____________________________ Cell Phone: _____________________________
PREVIOUS Home Address: _______________________________________________________________________
# Street Apt # City State Zip Code
NEW Home Address: ____________________________________________________________________________
# Street Apt # City State Zip Code
Parent/Guardian Signature: _________________________________________ Date:_____________________
Updated 3/8/2018
Student last name
Name of LEA
Central Registration sta will assist in providing “Name of school” to newly registering families.
Street address
The answer you give below will help the district determine what services you or your child may be able to receive
under the McKinney-Vento Act. Students who are protected under the McKinney-Vento Act are entitled to immediate
enrollment in school even if they don’t have the documents normally needed, such as proof of residency, school records,
immunization records, or birth certicate. The McKinney-Vento Act may also entitles students to free transportation and
other services.
If any box other than “In permanent housing” is checked, a STAC-202 form must also be completed.
A City School District of Albany sta member can assist you in completing the STAC-202 form.
Where is the student currently living? (Please check one box)
In a shelter
With another family or other person because of loss of housing or as a result
of economic hardship (sometimes referred to as “doubled-up”)
In a hotel/motel
In a car, park, bus, train, or campsite
Other temporary living situation (Please describe):
In permanent housing
Apt. # City State Zip code
Student rst name Student middle name
Name of school
City School District of Albany
Student Registration
Housing Questionnaire
Grade Gender ID (optional)
Home phone
Date of birth
day/month/ year
Print name of Parent, Guardian, or
Student (for unaccompanied homeless youth)
Signature of Parent, Guardian, or
Student (for unaccompanied homeless youth)
Date
Revised March 2020
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City School District of Albany Change of Address (City of Oakland)

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Completed 4 November 2020

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