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Children Attending CCSD: Yes No Residence is: Owned Rented / Leased
**Proof of Residency Attached: Current Signed Lease or Deed
3 pieces of current mail rec’d
**Proof of Residency to address for Co-Resident: Current Business mail received to this address
Has this student(s) been denied as a Non-Resident or transfer student? Yes No
District Admissions – East
5416 S Riviera Way
Centennial, CO 80015
720-886-7480
Co-Resident Registration
Form must be complete and Signatures notarized prior to approval (no electronic signatures)**Include ALL required documents
Resident Information: Date:
Name:
Address: , ,
( Number & Street) (City) (Zip Code)
Home Phone Number:
Current Gas/Electric Bill (30 day)
(new lease agreement or deed must be within the last two months)
Co-Resident Information:
Parent/Guardian Name:
Student Name(s): , ,
Move-in Date: Expected Move-out Date:
Reason for Co-Residency:
USPS mailed Change of Address confirmation
New Colorado drivers’ license
Other
Under penalty of perjury, I affirm that all information given above is true and correct. I further understand and
agree that, if it is later determined that this family is not a legal resident of Cherry Creek School District #5,
such students will be withdrawn immediately from Cherry Creek Schools. I further agree to pay Cherry Creek
Schools any and all applicable tuition charges that may be due, together with the cost of collection thereof,
including reasonable attorney’s fees. A person commits perjury if the individual makes a materially false
statement with the intent to mislead a public servant in the performance of his duty, which the individual does
not believe to be true, while the individual is under a required oath or authorized by law. Colorado Revised Statutes,
Sec 18-8-503, 18-1.3-501
(Resident Signature) (Co-Resident Signature)
State of Colorado, County of
The foregoing instrument was acknowledged before me this (date)
by and .
(Name of Resident) (Name of Co-Resident)
(Notary’s Official Signature)
My Commission Expires:
For District Admissions Use Only:
Photo identifications and signatures of Resident and Co-Resident verified by .
Revised 10/2020
Notary Seal
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Completed 9 June 2022

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