dunwoody high schooldunwoodyhs.dekalb.k12.ga.us/downloads/12th grade registration p… · creative...

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COLLEGE PREP All classes at DHS are taught at a college preparatory level. ACCELERATED/GIFTED This is for students who want a more rigorous class and are extremely strong in the subject area. CO-TAUGHT This is for students who have an IEP. ESOL Courses for English Language Learners ADVANCED PLACEMENT The curriculum is college level and developed by College Board. HIGH SCHOOL LEVELS Dunwoody High School 2020-2021 Rising 12 th Grade Course Request Form Parents: Please complete the top of this form. Student Name _____________________________ ID Number _______________________ Parent Signature ___________________________ Date ____________________________ **All Dual Enrollment Courses require an application to Georgia State Perimeter College. 1. Required English: British Literature: ____ College Prep _____Accelerated/Gifted ____ Co-Taught Or _____ *Advanced Placement Literature _____ **Dual Enrollment English 2. Required Math: (GSE – Georgia Standards of Excellence) GSE Pre-Calculus: _____ College Prep _____ Co-Taught Advanced Math Decision Making: _____ College Prep _____ Co-Taught _____ Calculus _____ *Advanced Placement Statistics _____ **Dual Enrollment Math _____ *Advanced Placement Calculus AB _____ *Advanced Placement Calculus BC (Prerequisite AP Calculus AB) _____ Multivariable Calculus 3. Required Science: (only one class required) _____ Oceanography _____ Oceanography Co-Taught _____ *AP Environmental Science _____ Chemistry _____ *AP Computer Science _____ *AP Biology _____ **Dual Enrollment Science _____Human Anatomy/Physiology 4. Required Social Studies: Economics: _____ College Prep _____ Co-Taught Or _____*AP Macroeconomics _____ **Dual Enrollment Economics *Advanced Placement Course Expectations: Students and Parents should consider the expectations, rigor, and level of independence required in an Advanced Placement Course, as these courses are taught at a college level. Students are encouraged to discuss these areas with the instructor. Once an AP Course is placed on a student’s schedule, they may not be able to drop the course. Application #__________________ Parent cell #__________________ Parent email__________________ _____________________________

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Page 1: Dunwoody High Schooldunwoodyhs.dekalb.k12.ga.us/Downloads/12th Grade Registration P… · creative aspects of music and appreciation of music. Stresses individual progress and learning

COLLEGE PREP

All classes at DHS

are taught at a

college

preparatory level.

ACCELERATED/GIFTED

This is for students

who want a more

rigorous class and

are extremely

strong in the

subject area.

CO-TAUGHT

This is for students

who have an IEP.

ADVANCED

PLACEMENT

The curriculum is

college level and

developed by

College Board.

HIGH SCHOOL

LEVELS

COLLEGE PREP

All classes at DHS are taught at a college preparatory level.

ACCELERATED/GIFTED

This is for students who want a more

rigorous class and are extremely strong in

the subject area.

CO-TAUGHT

This is for students who have an IEP.

ESOL

Courses for English Language Learners

ADVANCED PLACEMENT

The curriculum is college level and

developed by College Board.

HIGH SCHOOL

LEVELS

Dunwoody High School 2020-2021 Rising 12th Grade Course Request Form

Parents: Please complete the top of this form. Student Name _____________________________ ID Number _______________________

Parent Signature ___________________________ Date ____________________________

**All Dual Enrollment Courses require an application to Georgia State Perimeter College. 1. Required English:

British Literature: ____ College Prep _____Accelerated/Gifted ____ Co-Taught

Or_____ *Advanced Placement Literature _____ **Dual Enrollment English

2. Required Math: (GSE – Georgia Standards of Excellence)

GSE Pre-Calculus: _____ College Prep _____ Co-Taught

Advanced Math Decision Making: _____ College Prep _____ Co-Taught

_____ Calculus _____ *Advanced Placement Statistics

_____ **Dual Enrollment Math _____ *Advanced Placement Calculus AB

_____ *Advanced Placement Calculus BC (Prerequisite AP Calculus AB)

_____ Multivariable Calculus

3. Required Science: (only one class required)

_____ Oceanography _____ Oceanography Co-Taught

_____ *AP Environmental Science _____ Chemistry

_____ *AP Computer Science _____ *AP Biology

_____ **Dual Enrollment Science _____Human Anatomy/Physiology

4. Required Social Studies:

Economics: _____ College Prep _____ Co-Taught Or_____*AP Macroeconomics _____ **Dual Enrollment Economics

*Advanced Placement Course Expectations:Students and Parents should consider the expectations, rigor, and level of independence required in an Advanced Placement Course, as these courses are taught at a college level. Students are encouraged to discuss these areas with the instructor. Once an AP Course is placed on a student’s schedule, they may not be able to drop the course.

Application #__________________Parent cell #__________________Parent email_______________________________________________

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Please number your request in order - 1st choice, 2nd choice, 3rd choice, 4th choice, 5th choice, and 6th choice. Your 5th and 6th choice will be your alternate choices in case of conflicts in your schedule.

World Language and World Language Pathway Courses: (if applicable) _____ Spanish I _____ Spanish I (Co-Taught) _____ Spanish for Native Speakers I _____ Spanish II _____ Spanish II (Co-Taught) _____ Spanish for Native Speakers II _____ Spanish III _____ Spanish IV _____ Spanish V _____ *AP Spanish Language _____ *AP Spanish Literature _____ Spanish VI _____ Latin I _____ Latin II _____ Latin III _____ Latin IV _____ Latin V _____ *AP Latin _____ French I _____ French II _____ French III _____ French IV _____ French V _____ *AP French _____ German IV _____ German V _____ *AP German

Humanities Pathway Courses:

_____ Band _____ AP Music Theory

_____ Drama _____ Technical Theatre _____ Chorus

_____ Orchestra _____ Visual Arts _____ *AP Art

_____ * AP Human Geography _____ * AP Gov’t & Politics

_____ *AP European History _____ *AP Psychology _____ *AP Comparative Gov’t

CTAE (Career, Technical & Agricultural Education) Pathway Courses:

_____ Aerospace Science Pathway _____ Healthcare Science Pathway

______ Interior Design Pathway ______ Food, Nutrition & Wellness Pathway

_____ Early Childhood Education Pathway _____ Digital Technology Pathway

____ Engineering Pathway (one course per year allowed)

_____ DeKalb High School of Technology North at Cross Keys High School (See Counselor)

_____ Work-Based Learning ( See Counselor)

Additional Electives: _____ PE I _____ Exercise Weight Control (Yoga) _____ Physical Conditioning

_____ Writer’s Workshop _____ Study Skills (IEP Required)

This section is only for students currently enrolled in one of the programs below. _____ Academy Of Finance – Mr. Fortenberry _____ Academy of Mass Communication – Mrs. Wichman _____ Journalism Pathway (Yearbook) – Mr. Siegel

Received by Counselor: ______/_______/20______ Last Updated 7/16/2020 11:51:46 AM

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Elective Foundation Course Descriptions

Intermediate Band - Provides opportunities for intermediate-level performers to increase performance skills and precision on a wind or percussion instrument. Includes performance and production, analysis and theoretical studies, historical and cultural contributions and influences, creative aspects of music and appreciation of music. Stresses individual progress and learning and group experiences; strengthens reading skills. Beginning Chorus - Provides opportunities to develop performance skills and knowledge in mixed choral singing. Covers performance and production, analysis and theoretical studies, historical and cultural contributions and influences, creative aspects of music and appreciation of music. Organizes objectives for self-paced progress through all four levels. Stresses individual progress and group experiences. Drama I – This course serves as prerequisite for other theater/drama courses. Develops and applies performance skills through access to basic vocal, physical and emotional exercises; includes improvisation and scene study and related technical art forms. Orchestra I - Provides opportunities for intermediate-level performers to increase performance skills and precision on orchestral stringed instruments. Covers performance and production, analysis and theoretical studies, historical and cultural contributions and influences, creative aspects of music and appreciation of music. Organizes objectives for self-paced progress through all four levels. Stresses individual progress and group experiences. Visual Arts I - Introduces art history, art criticism, aesthetic judgment and studio production. Emphasizes the ability to understand and use elements and principles of design through a variety of media, processes and visual resources. Explores master artworks for historical and cultural significance. AEROSPACE SCI. LEAD 100: Aerospace Science: A Journey into Aviation History and Leadership I - This is the recommended first AS course for all new cadets. It is an aviation history course focusing on the development of flight throughout the centuries. It starts with ancient civilizations, then progresses through time to modern day. The emphasis is on civilian and military contributions to aviation; the development, modernization, and transformation of the Air Force; and a brief astronomical and space exploration history. It is interspersed with concise overviews of the principles of flight to include basic aeronautics, aircraft motion and control, flight power, and rockets. Throughout the course, there are readings, videos, hands-on activities, and in-text and student workbook exercises to guide in the reinforcement of the materials. Many of the 72 hours dedicated to leadership studies relate directly to the academic subject matter. The LE-100 textbook introduces cadets to the Air Force Junior Reserve Officer Training Corps (AFJROTC) program providing a basis for progression through the rest of the AFJROTC program while instilling elements of good citizenship. It contains sections on cadet and Air Force organizational structure; uniform wear; customs, courtesies, and other military traditions; health and wellness; fitness; individual self-control; and citizenship. Foundations of Interior Design - This course introduces the student to the basic fundamentals of design and the interior design profession. The skills taught throughout the course will allow the student to investigate and explore the various careers within the aspects of interior design. Students will gain knowledge of the history of interior furnishings. Basic mathematics, English language arts and science skills will be incorporated throughout the curriculum. Individual work, teamwork and presentation skills will also be incorporated into the curriculum.

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Elective Course Descriptions Food Nutrition Wellness Pathway - Food, Nutrition and Wellness is an essential course in understanding nutritional needs and food choices for optimal health of individuals across the lifespan. Interrelationships with wellness are explored. This course leads to the advanced nutrition pathway and develops a knowledge base and the skills necessary to select among alternatives in the marketplace, with an emphasis on nutrient content, the development of chronic diseases, and food safety. Early Childhood Education I – This course is the foundational course under the Early Childhood Care & Education pathway and prepares the student for employment in early childhood education and services. The course addresses the knowledge, skills, attitudes, and behaviors associated with supporting and promoting optimal growth and development of infants and children. The prerequisite for this course is advisor approval. Introduction to Digital Technology - The foundational course for Web & Digital Communications, Programming, Advanced Programming, Information Support & Services, and Network Systems pathways. This course is designed for high school students to understand, communicate, and adapt to a digital world as it impacts their personal life, society, and the business world. Exposure to foundational knowledge in hardware, software, programming, web design, IT support, and networks are all taught in a computer lab with hands-on activities and project-focused tasks. Students will not only understand the concepts, but apply their knowledge to situations and defend their actions/decisions/choices through the knowledge and skills acquired in this course. Employability skills are integrated into activities, tasks, and projects throughout the course standards to demonstrate the skills required by business and industry. Competencies in the co-curricular student organization, Future Business Leaders of America (FBLA), are integral components of both the employability skills standards and content standards for this course. Various forms of technologies will be highlighted to expose students to the emerging technologies impacting the digital world. Professional communication skills and practices, problem-solving, ethical and legal issues, and the impact of effective presentation skills are taught in this course as a foundational knowledge to prepare students to be college and career ready. The knowledge and skills taught in this course build upon each other to form a comprehensive introduction to digital world. Introduction to Digital Technology is a course that is appropriate for all high school students. Foundations of Engineering and Technology – This is the introductory course for the Engineering and Technology Education pathways. This STEM driven course provides the students with an overview of engineering and technology including the different methods used in the engineering design process developing fundamental technology and engineering literacy. Students will demonstrate the skills and knowledge they have learned through various project based activities while using an engineering design process to successfully master the “E” in STEM. Engineering Concepts – This is second course in the Engineering and Technology Pathway. Students will learn to design technical solutions to engineering problems using a whole systems approach to engineering design. Students will demonstrate the application of mathematical tools, teamwork, and communications skills in solving various design challenges, while maintaining a safe work environment. The prerequisite for this course is Foundations of Engineering and Technology.

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Student Records Request

Information Requested by:

School Name: Dunwoody High School in DeKalb County School District

Address: 5035 Vermack Road, Dunwoody, GA 30338

Phone: 678-874-8506 Fax: 678-874-8510 Date of Request: / / .

Requested by: Pamela Holloway, Registrar Email: [email protected]

Please send the records for the following student:

Student’s Name: ______________________________________________________________________________________

(Last) (First) (Middle) (Suffix)

Date of Birth: / / .

Last School Attended:____________________________________ County:________________________ State:__________

School Address: ______________________________________________________________________________________

Phone:_______________________________ Fax: _____________________________

□Withdrawal Form including grades

□Current Grade Level ___________

□Official Transcript (Please fax and mail official transcript)

□Disciplinary Record

□Current Testing Data

□9th Grade Entry Date / / .(if applicable)

□Other ______________________________________________________________________

Parent or Guardian Signature:_____________________________________________________ Date: / / .

Per Georgia DOE Board Rule 160-5-1-14 schools must mail or otherwise deliver records within ten (10) calendar days

of receipt of request. Schools shall not withhold any student record because of non-payment of fees.

The final regulations of the Family Education Rights and Privacy Act (FERPA), 1976 (Buckley Amendment) no longer

requires written parental consent to release student educational records between schools. These rules state that school

officials in school systems in which the student may intend to enroll may release and receive student's records without

written consent for each release.

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Class of 2012 and subsequent years

DEKALB COUNTY SCHOOL DISTRICT PROGRAM OF STUDY SELECTION/ADVISEMENT FORM

STUDENT: _______________________________________ TEAM/HOMEROOM: ________________ Date: _________________

CAREER INTEREST: ________________________________________________ Contact Number: _________________________

DIPLOMA SEAL: Select type of diploma seal by placing a √ in the appropriate box.

Courses

General Education Diploma

(Check One)

Transition Diploma

Students with Disabilities

(SWD)

Students with Disabilities

(SWD)

College Preparatory

Seal

Career Technology

Seal

Honors /Distinction Seal

Required course work

determined by Individualized Educational

Program (IEP)

English* 4 4

Access Courses 4 4 4

Math *

3 as determined by the IEP

4 Access Courses

4 4 4

Science* 4 4th science can meet science or elective requirement

4 Access Courses

4 4th science can meet science or elective requirement

4 4th science can meet science or elective requirement

4 4th science can meet science or elective requirement

Social Studies* Rq’d .5 Am. Govt.

- .5 World Geography1 World History1 U.S. History

^ 1 Economics

4 4 Access Courses

4 4 4

Health/Physical Education .5 Health .5 PE 1 **

2 2 Access Courses

2 2 2

Electives ***

Humanities *** World Languages* Career Technology***

6 2 units of math support classes required *No ForeignLanguage asdetermined byIEP

General Electives determined by IEP

6 Access Courses

6 *2 Units of thesame World Languagerequired

***3 Units of Career Tech in the same pathway required or 3 Units of Humanities

1 General Elective

6 *1 Unit of aWorld Languagerequired

***3 Units of Career Tech in the same pathway required

2 General Electives

6

*3 Units of thesame World Languagerequired

3 General Electives

Totals 24 24 24 24 24

†Requires 3.5 Cumulative Grade Point Average (CUGPA) and a 3.0 Core Grade Point Average (CGPA)

*Core Courses

**One unit may be exempt through validated full-year participation in school sponsored athletics, marching band, dance and/or JROTC.

***Students are required to select elective courses based on the area of concentration with a minimum of three (3) units within the area of Career Technology or a minimum of three (3) units within the area of Humanities. Career Technology units must be in one of the following areas: BUS ED, FCS, TE, T&I or JROTC. Humanities include the following areas: World Languages, +ESOL, Fine Arts, Visual Arts, Performing Arts, ELA and Social Studies.

+All identified ELL students must be enrolled in an ESOL course. Course level placement must be made per results of the ACCESSand/or WIDA Standards Language Proficiency Level. For approved ESOL delivery models, please refer to GaDOE ESOL ResourceGuide.

^Transfer students who have earned 0.5 CU for Economics have met state requirements; therefore, transfer students must take another 0.5 CU social studies elective to meet local graduation requirements.

- Transfer students who have not successfully completed 0.5 CU of World Geography may substitute another 0.5 CU social studieselective to meet local graduation requirements.

Parent’s/Guardian’s Signature: __________________________________________________________ Date: __________________

Counselor’s Signature: _________________________________________________________________ Date: __________________

Student’s Signature: ___________________________________________________________________ Date: __________________

BOE Approved 8-2-10

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Robert R. Freeman Administrative Complex 1701 Mountain Industrial Blvd. | Stone Mountain, GA 30083 678.676.1200 | www.dekalbschoolsga.org

Media Release Form I [student name], agree to grant DeKalb County School District and its assigns the right to use photo and/or video images and sound for use in news and/or educational programs in whole or in part for any currently known media or media to be developed.

I agree to release the DeKalb County School District from any and all claims, damages, liabilities and costs I now or might have regarding my appearance in association with news stories and/or educational programs.

I hereby release all rights that I, my heirs, or assigns might have now or in the future to all or part of the said production, including but not limited to, the publishing, printing, development, editing, and use in newspapers and other forms of print and digital media (including social media), broadcasting, cablecasting, webcasting, podcasting, video on demand, or any other public or private presentation or screening purposes by the DeKalb County School District or its assigns.

I knowingly and willing waive any and all rights or entitlements, including payments for my appearance or for the subsequent distribution of the products related to this program.

Student Signature Date

Parent or Guardian Signature [required if under 18] Date

DeKalb County School Representative Date

Watch DeKalb Schools TV (DSTV) at www.dekalbschoolsga.org/communications/dstv “Like” us on facebook.com/dekalbschoolsga

Follow on Instagram, Twitter and YouTube @dekalbschools

07/16/2020

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NOTARIZED AFFIDAVIT OF RESIDENCE FORM DOE Rule 160-5-1-.28

DeKalb Board of Education Policies AD and JBC

I. Instructions for Completing Affidavit of Residence

This form is to be completed for a student attending a school within the DeKalb County School District who resides with his or her parent(s) or legal guardian(s), but whose residence is located in the home of another adult living within the boundaries of the DeKalb County School District. The Affidavit of Residence is valid for the current school year only, as long as the student and the student’s parent(s) or legal guardian(s) continue to reside at the address listed on the affidavit during that school year. The affidavit must be submitted annually before the start of each school year or upon moving into the attendance area of the new school.

Parent(s) or legal guardian(s) must submit the Affidavit of Residence and all required documents (listed below) to the school within the 30 days of the date that the Notary Public certifies the Affidavit of Residence.

II. Procedures to Verify Co-Residence (Four Steps)

Prior to Coming to the School: 1. Parent(s)/legal guardian(s) obtains a copy or prints the five page affidavit form (this document); and 2. Parent(s)/legal guardian(s) must complete pages two-three (2-3) of the affidavit form (this

document) in the presence of a Notary Public and have the Notary Public certify the document.

Parent/Legal Guardian and Owner/Lessee Come to School Together: 3. Owner/lessee completes page four (4) in the presence of a school official; and 4. The parent(s)/legal guardian(s) and the owner/lessee must both be present to submit the required

documents (listed in Section IV below) to the school (no exceptions will be made).

III. Reminders 1. If the parent(s)/legal guardian(s) and student move from the attendance area of the school in which

the student is enrolled, the Affidavit of Residence is null and void. 2. If the parent(s)/legal guardian(s) would like the student to continue attending a school,

parent(s)/legal guardian(s) must follow the same procedures and re-submit the Affidavit of Residence and all required documents each year.

IV. Required Documents for Proof of Residence

Parent(s)/Legal guardian(s): (1) Completed Affidavit of Residence (pages 2-3) that is certified by a notary public before coming to school; (2) photo ID; and (3) piece of official business mail addressed to the parent(s) / legal guardian(s) at the address listed on Affidavit of Residence. All three of these items are required.

Owner/Lessee: (1) Page 4 of the Affidavit of Residence (completed in the presence of a school official— please wait to fill out until the visit to the school); (2) photo ID; (3) apartment/house lease or mortgage deed and (4) current utility bill (must be gas, electric, or water) in the name of the owner/lessee. All four of these items are required.

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Pages Two and Three of the Affidavit of Residence must be completed by the student’s parent(s) or legal guardian(s) and witnessed by a notary public before coming to the school.

Affidavit of Parent(s) or Legal Guardian(s)

I, , of lawful age, being first duly sworn under oath state that: Print Full Name

1. I presently and permanently reside at

which is my legal residence located in DeKalb County, Georgia but outside the city limits of Atlanta or Decatur.

2. I am the parent or legal guardian of , Print Student’s Full Name

, , Print Student’s Full Name Print Student’s Full Name

, , Print Student’s Full Name Print Student’s Full Name

who reside(s) with me at the address listed in paragraph 1 above.

3. My child(ren) and I began residing at the address listed above on / / . Month Day Year

4. The name and last known address of the student’s parent(s) or legal guardian(s):

Parent(s) or Legal Guardian(s) Name

Address

Affirmations:

1. I attest that this request to attend is not primarily intended to allow the student to attend a particular school that he or she would not otherwise be able to attend because it is outside of his or her designated attendance area, nor is this affidavit being completed for the purpose of participating in athletics at a particular school, to utilize special services or programs offered at a particular school, or any other similar reason.

2. I further attest that the student(s) named above is (are) not currently under a long-term suspension or expulsion

from his/her/(their) most recent school nor is he/she/(their) currently subject to a recommendation for long-term suspension or expulsion from his/her most recent school.

3. I understand that if any of the information provided on this affidavit is changed for any reason, it is my

responsibility to immediately notify the school system.

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4. I also understand that the DeKalb County School District Superintendent or designee may verify the facts contained in this affidavit and conduct an audit on a case-by-case basis after the student has enrolled in a public school with the DeKalb County School District. The audit may include a personal visit to the student’s home at the residence listed in this affidavit by a school district attendance officer or other employee of the District to verify the facts sworn to in this affidavit.

NOTICE OF PENALTIES AND CRIMINAL LIABILITY

I, understand that if I provide false information or defraud the DeKalb County School District on this Affidavit of Residence, I will be required to pay for the costs incurred by the District for the period that the ineligible student is enrolled, as set forth in O.C.G.A. § 20-2-133.

If the costs incurred by the DeKalb County School District are collected by an attorney, I may be obligated to pay for all expenses and attorneys’ fees incurred by the Board of Education in the collection of same.

I may be prosecuted, held criminally liable and imprisoned for not less than one nor more than ten years if I am found guilty or forgery in the first degree, pursuant to O.C.G.A. § 16-9-1.

I may be prosecuted, held criminally liable, and imprisoned for not less than one nor more than five years if I am found guilty of forgery in the second degree, pursuant to O.C.G.A. § 16-9-2.

I may be prosecuted, held criminally liable, and punished by a fine of not more than $1,000.00 or by imprisonment for not less than one nor more than five years, or both, if I am found guilty of making false statements pursuant to O.C.G.A. § 16-10-20.

I may be prosecuted, held criminally liable and punished by a fine of not more than $1,000.00 or by imprisonment for not less than one nor more than five years, or both if I am found guilty of false swearing pursuant to O.C.G.A. § 16-10- 71.

By executing this affidavit, I solemnly swear or affirm under the penalties listed above that the contents of this affidavit are true and accurate.

Signature of Parent / Legal guardian Date

Section for Notary Public

SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME ON THIS

day of , 201 ,

_ [Notary Seal] Notary Public

My Commission Expires:

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This page (page 4) is to be completed by the owner/lessee in the presence of a school district official. Please DO NOT fill out this page until you arrive at the school.

Sworn Statement of Owner/Lessee

I, , of lawful age, certify that I am the (circle one) owner /lessee of the premises identified in paragraph 1 on page 2 of the Affidavit of Residence, and that the above named parent(s)/ legal guardian(s) and student(s) permanently reside at the address identified in paragraph 1 on page 2 of the Affidavit of Residence.

NOTICE OF PENALTIES AND LIABILITY

I, understand that I may be subject to the following criminal liability for engaging the following conduct.

I may be prosecuted, held criminally liable and imprisoned for not less than one nor more than ten years if I am found guilty or forgery in the first degree, pursuant to O.C.G.A. § 16-9-1.

I may be prosecuted, held criminally liable, and imprisoned for not less than one nor more than five years if I am found guilty of forgery in the second degree, pursuant to O.C.G.A. § 16-9-2.

I may be prosecuted, held criminally liable, and punished by a fine of not more than $1,000.00 or by imprisonment for not less than one nor more than five years, or both, if I am found guilty of making false statements pursuant to O.C.G.A. § 16-10-20.

I may be prosecuted, held criminally liable and punished by a fine of not more than $1,000.00 or by imprisonment for not less than one nor more than five years, or both if I am found guilty of false swearing pursuant to O.C.G.A. § 16-10- 71.

By executing this statement, I solemnly swear or affirm under the criminal penalties listed above that the contents of this statement are true and accurate.

Signature To be signed in the presence of a school official

Date:

Owner /Lessee Name Print Full Name

Address

Email________________________________________ Phone_______________________________________

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For School Use

Any person making application to enroll a student using an affidavit must provide the following documents as proof of residency (please initial that you have viewed or received documents, as required):

Parent/Guardian: 1. Copy of business letter from the parent’s or legal guardian’s place of employment or other official business letter addressed to the parent(s) or legal guardian(s) at the address listed on the affidavit.

2. Copy of picture ID for the parent or legal guardian requesting to enroll a child.

Owner/Lessee: 3. Current utility bill in the name of the owner or lessee (gas, electric, or water)

4. Copy of the current lease or mortgage deed

5. Copies of picture ID for the owner /lessee

6. Observed owner/lessee fill out pages 4 in front of registrar.

School Official (print): Date

Name of School: School Year:

Students on Affidavit Name Pupil Number

1.

2.

3.

4.

5.

6.