Please read all information carefully!

(1)

Residency Affidavit Exhibit C

Please read all information carefully!

In order to reduce the number of individuals visiting the Administration Building, please send completed forms with attachments to

residency@nederlandisd.org.

There is a minimum of a 3 business day approval process for ALL Residency Affidavits.

 All pages must be completed, including all signatures notarized

 All attachments MUST be submitted with Affidavit:

a) Parent driver’s license with corresponding NISD address

b) Copy of current Lease (listing everyone living in apartment/house) OR current Mortgage statement

c) Residents driver’s license with corresponding NISD address

d) Most current Entergy bill. No other form of utility bill will be accepted.

Please direct all questions to residency@nederlandisd.org.

I acknowledge that I have read, understand and have attached all necessary documents to this affidavit. I also understand that my Residency Affidavit will not be processed if all forms are not complete and all attachments have not been attached.

_____________ Date: _

Parent/Guardian

(2)

Sworn Statement for Parents - Residency Affidavit

2021-2022 School Year

(To be completed by Parent/Guardian residing with resident on mortgage or lease) (Valid for the 2021-2022 School Year only)

Parent/Guardians, who are currently residing with persons having a legal residence within the boundaries of the Nederland

Independent School District and whose Enrollee(s) will attend the district’s schools, are required to declare the circumstances which make this arrangement necessary. They will be further required to declare that no false information has been provided to Nederland ISD concerning their current residency status.

I, ___________________________________________________, do hereby declare that my family will be (Parent/Guardian of each Student)

residing in the home of:

Resident’s Name: ___________________________________________________________________________

Relationship: _______________________________________________________________________________

Address: __________________________________________________________________________________

Street Address City Zip

Resident’s Primary Telephone: ___________________________ Alternate Telephone: ____________________

Parent/Guardian Primary Telephone: _______________________ Alternate Telephone: ___________________

Parent/Guardian e-mail address: _______________________________________________________________

Previous address and telephone: _______________________________________________________________

Reasons for moving in: _______________________________________________________________________

Does your Enrollee currently, or plan to participate in extracurricular activities such as athletics and fine arts?

Yes No If Yes, please describe:____________________________________________

Length of time planning to be at this residence: ____________________________________________________

Name of Enrollee Age Grade

__________________________________________________________________________________________

*Please note: Only one student per original affidavit.

FALSIFICATION OF INFORMATION ACKNOWLEDGEMENT

I declare that I have provided no false information to the Nederland Independent School District (NISD) regarding this residency document. I understand that falsifying this sworn affidavit is a criminal offense (Perjury) under Section 37.01 of the Texas Penal Code, which is a Class A misdemeanor punishable to one (1) year of confinement in jail; a fine not to exceed $2000.00; or both such fine and imprisonment. Another criminal offense for falsifying this residency information is a violation of Texas Penal Code 37.10:

Tampering with a Government record.

(3)

Residency Affidavit Exhibit C Further, such person is liable to the district for the period during which the ineligible student is enrolled, for the greater of:

1) the maximum tuition fee allowed under Section 25.038 of the Texas Education Code; or 2) the amount the district has budgeted for each student as maintenance and operating expenses.

The regular tuition rate is $31.64 per school day for 2021-2022 school year.

*Please Note: No copies or notary services are available at this location.

I understand that the Enrollee residing with me on condition of this affidavit may be withdrawn from Nederland ISD if I have provided false testimony for this Enrollee. I also understand that Nederland ISD reserves the right to investigate claims of residence under Nederland ISD administrative guidelines.

Signed the _________ day of ________________________________________________________, 20___ .

____________________________________________________________________________________

Signature of Parent/Guardian Typed or Printed Name of Parent/Guardian

STATE OF TEXAS

COUNTY OF _____________________________________

BEFORE ME, the undersigned authority, on this day personally appeared

______________________________________, known to me by ________________________ to be the

(Parent/Guardian signing form) (ID, Passport, etc.)

person whose name is subscribed to the foregoing instrument and acknowledged Affiant’s personal knowledge is true and correct and the information is being communicated to the Nederland Independent

School District (“NISD” or the “District”) for the purpose of enrolling a Enrollee in the district’s schools..

SUBSCRIBED AND SWORN TO BEFORE ME by _______________________________________________

on this the __________ day of ______________________________________, 20_____.

________________________________________________

Notary Public, State of Texas [Seal]

[Seal]

(4)

Sworn Statement for Non-Parents - Residency Affidavit

(To be completed by resident on Mortgage/Lease of property)

Any person attempting to enroll a Enrollee in the Nederland Independent School District who cannot produce a property deed or lease or qualify as homeless under the McKinney-Vento Act must ask the owner or lessee of the property where the person lives to complete and sign this affidavit.

It is the responsibility of the person seeking to enroll the Enrollee (not the person who completes this affidavit) to attach a record of the recent rent payment, unless this affidavit affirms that the payment of rent is not required. The information contained in this affidavit is subject to verification by the District.

Residents living within the boundaries of the Nederland Independent School District who provide housing for anyone who will be attending school in the Nederland Independent School District, other than immediate family members, are required to sign the following statement declaring that no false information has been provided to the district and to provide the district with verification of residence.

I, __________________________________________________________________, do hereby declare that the

Below listed person(s) are currently residing in my home at:

__________________________________________________________________________________________

Address

Names of the person’s that have moved in with you in regards to this affidavit:

___________________________________________ ___________________________________________

Resident’s Primary Telephone Number: __________________________________________________________

I declare that I have provided no false information to the Nederland Independent School District (NISD) regarding this residency document. I understand that falsifying this sworn affidavit is a criminal offense (Perjury) under Section 37.01 of the Texas Penal Code, which is a Class A misdemeanor punishable to one (1) year of confinement in jail; a fine not to exceed $2000.00; or both such fine and imprisonment. Another criminal offense for falsifying this residency information is a violation of Texas Penal Code 37.10:

Tampering with a Government record.

Further, such person is liable to the district for the period during which the ineligible student is enrolled, for the greater of: 1) the maximum tuition fee allowed under Section 25.038 of the Texas Education Code; or 2) the amount the district has budgeted for each student as maintenance and operating expenses.

The regular tuition rate is $31.64 per school day for 2021-2022school year.

(5)

Please Note: No copies or notary services are available at this location.

I understand that the Enrollee residing with me on condition of this affidavit may be withdrawn from Nederland ISD if I have provided false testimony for this Enrollee. I also understand that Nederland ISD reserves the right to investigate claims of residence under Nederland ISD administrative guidelines.

Signed the _________ day of ________________________________________________________, 20___ .

_______________________________________________________________________________________

Signature of Resident of District Typed or Printed Name of Resident of District

STATE OF TEXAS

COUNTY OF _____________________________________

BEFORE ME, the undersigned authority, on this day personally appeared

______________________________________, known to me by ________________________ to be the (Resident of NISD signing form) (ID, Passport, etc.)

person whose name is subscribed to the foregoing instrument and acknowledged Affiant’s personal knowledge is true and correct and the information is being communicated to the Nederland Independent

School District (“NISD” or the “District”) for the purpose of enrolling a Enrollee in the district’s schools..

SUBSCRIBED AND SWORN TO BEFORE ME by _______________________________________________

on this the __________ day of _________________________________________, 20_____.

________________________________________________

(6)

Nederland ISD

Residency Affidavit for Land Lord/Shared Tenancies

Any person attempting to enroll a Enrollee in the Nederland Independent School District who cannot produce a property deed or lease or qualify as homeless under the McKinney-Vento Act must ask the owner or lessee of the property where the person lives to complete and sign this affidavit.

It is the responsibility of the person seeking to enroll the Enrollee (not the person who completes this affidavit) to attach a record of the recent rent payment, unless this affidavit affirms that the payment of rent is not required. The information contained in this affidavit is subject to verification by the District.

Please complete the items below and sign in the presence of a notary.

My name is _____________________________________________(I will sign page 6 and have my signature notarized) And I hereby swear and affirm as follows:

I am the owner/lessee of property located at ______________________________________________________ In the city of ______________________ and within the NISD boundaries.

A: IF PROPERTY IS A RENTAL:

________________________________________________________, who is the parent or legal guardian of

________________________________________________________, leases or subleases the Premise from me as his or her primary, physical place of residence with/without a written lease, in a tenancy at-will, from month-to-month, and (check one)

___________ I have received rental payment from the parent or guardian named above within the last thirty (30) days for the lease of the Premises OR

___________ The parent or guardian named above resides at the Premises with no payment of rent.

B: IF PROPERTY IS SHARED:

________________________________________________________, who is the parent or legal guardian of ________________________________________________________, resides with me at the Premises as his or her primary, physical place of residence.

(7)

I declare that I have provided no false information to the Nederland Independent School District (NISD) regarding this residency document. I understand that falsifying this sworn affidavit is a criminal offense (Perjury) under Section 37.01 of the Texas Penal Code, which is a Class A misdemeanor punishable to one (1) year of confinement in jail; a fine not to exceed $2000.00; or both such fine and imprisonment. Another criminal offense for falsifying this residency information is a violation of Texas Penal Code 37.10: Tampering with a Government record.

Further, such person is liable to the district for the period during which the ineligible student is enrolled, for the greater of:

1) the maximum tuition fee allowed under Section 25.038 of the Texas Education Code; or 2) the amount the district has budgeted for each student as maintenance and operating expenses.

The regular tuition rate is $31.64 per school day for 2021-22 school year.

NOTE: Items to attach to this form are as follows:

1) Valid Resident Driver’s license with corresponding NISD address; 2) Valid Parent Driver’s license with

corresponding NISD address; 3) current Entergy bill only (NO water, gas, cable or phone bills will be accepted); 4) Mortgage statement, Deed or current lease with all persons living in home/apartment listed.

The information contained in this affidavit is subject to verification by the District.

Signed the _________ day of ________________________________________________________, 20___ .

______________________________________________________________________________________

Signature of Affiant Typed or Printed Name of Affiant

STATE OF TEXAS

COUNTY OF _____________________________________

BEFORE ME, the undersigned notary public, personally appeared

__________________________________________, who, under oath, deposed and said that the following is within said Affiant’s personal

knowledge and is true and correct and the information is being communicated to the Nederland Independent School District (“NISD” or the

“District”) for the purpose of enrolling a Enrollee in the district’s schools.

SUBSCRIBED AND SWORN TO BEFORE ME by ________________________________________________

on this the __________ day of _________________________________________, 20_____.

________________________________________________

(8)

NISD Office USE ONLY - Do Not Write Below This Line

NISD Decision: Approved Denied Revoked

Superintendent or Designee Signature: __________________________________________________________

Date: _Campus Name:_______________________

Grade: ___________________________

This affidavit is effective for the 20_ - 20_ school year ONLY

RESIDENCY AFFIDAVIT REVOKED BY NISD

Please read all information carefully!