March 1, 2017

Dear Senatobia Municipal School District Parent/Guardian:

The State of Mississippi requires that each student provide proof of residency each school year. If you currently have students

in Grades K through 11 in the Senatobia Municipal School District, you are required to provide proof of residency for the

2017/2018 school year. In order for a student to receive a final report card for this current year and/or a class assignment or

schedule for the 2017/2018 school year, proof of residency must be current.

Parents must provide three (3) documents for proof.

1. Filed Homestead Exemption Application Form, Mortgage Documents or Property Deed, or Apartment or Home

Lease (1)

2. Utility Bills (water, gas, electric, cable) (1)

3. Automobile Registration (1)

You will have three options to return the documents:

OPTION I: Parent should complete the top portion of the District Residency and Documentation Checklist form for each child.

Place the form(s) and a copy of the three required proofs inside the Residency Envelope and have your child return the

envelope to his or her homeroom teacher.

OPTION II: Complete and mail the form and documentation to the Central Office: 104 McKie Street, Senatobia, MS 38668.

OPTION III: Complete and hand deliver the form and documentation to the Central Office: 104 McKie Street.

The Residency Envelope will be given to the youngest child in the family and should be returned to school by the same child.

Please remember to return the Residency Envelope.

If this information has not been received by May 19, 2017, your child will not receive his or her final report card.

You need send only one copy of the required documents. Do not send originals because they will not be returned to you.

If the parent or guardian does not have a car or the car is in another person’s name, the parent or guardian will have to print

the Affividavit of Non-Ownership of Automobile from the district’s webpage and get it notarized. The notarized affidavit

should be included in the envelope. (Auto Affidavit cannot be used for shared residency.)

Parents who need to complete verification for shared residency can print the Shared Residency Affidavit form and directions

from the district’s website: www.senatobiaschools.com but will need to bring the notarized form and the required proofs to

the Central Office at 104 McKie Street. Do not return shared residency forms or documents. Shared residency will have to be

done in person with Nicole Lenard or me.

My office hours are from 7:30 to 4:30 on Tuesday and Thursday, but I will be glad to stay later if needed. Call me to set up an

appointment if you need to come in after 4:30. Nicole Lenard will be available Monday-Friday.

All forms are available on the district’s web page. Anyone who needs a hard copy of any form should come by the Central

Office.

Please do not hesitate to contact me if you have questions about this process.

Sincerely,

Bernice Jackson

662-562-4897

SENATOBIA MUNICIPAL SCHOOL DISTRICT RESIDENCY AND DOCUMENTATION CHECKLIST

SCHOOL YEAR 2017-2018

(TO BE COMPLETED BY PARENT or LEGAL GUARDIAN)

Name of Student: ___________________________________________________ Grade: ________

Name of Parent, Legal Guardian:

Address of Parent, Legal Guardian: Please note that a Post Office Box is not acceptable as a residence address.

Is your child currently under suspension or expulsion from another school district? Yes No

Home Language Survey (HLS)

1. Does your child speak any language other than English? ( ) Yes ( ) No

2. If yes, what was the first language your child learned to speak?

3. What language does your child speak most often?

4. Is this child a migrant student? ( ) Yes ( ) No

5. Is this child a homeless student? ( ) Yes ( ) No

6. Is this child a neglected and/or delinquent student? ( ) Yes ( ) No

7. Does this child have any disability (SPED) needs? ( ) Yes ( ) No

If yes, please explain

8. Does this child need speech services? ( ) Yes ( ) No

9. Is this child in a gifted program? ( ) Yes ( ) No

I hereby certify that the information given above on this form is a true and correct statement of my legal residence. Should my legal residence change while the above

listed student is enrolled in the above cited school district, I will promptly notify the appropriate officials of this school district. Further, I understand that a pupil is

not legally enrolled until this form is completed and signed by the parent, guardian, or other adult with whom the student may be living. I understand that a pupil

admitted under false information is not legally enrolled and is subject to penalty.

Signature of Parent, Legal Guardian Date Telephone Number

RESIDENCY REQUIREMENTS

(TO BE COMPLETED BY THE SCHOOL DISTRICT)

A Documents provided to me by Parent, Legal Guardian: (One document must be 1, 2 or 3, one must be #4, and one must be #5)

1. Filed Homestead Exemption Application Form

2. Mortgage Documents or Property Deed

3. Apartment or Home Lease (expiration date must be on lease and lease should be on official

letterhead and with phone number for contact person)

4. Utility Bills (water, gas, electric, cable) [Bill must be current—within 30 days of residency

verification.]

5. Automobile Registration (car tag receipt with name and physical address)

B Student is living with legal guardian and a certified copy of the Court Decree, or petition if pending was

received declaring that the guardianship was formed for a purpose other than establishing residency

for school district attendance purposes.

C A certified birth certificate is required of all children enrolling in the Senatobia Municipal School

District (includes parent’s names(s), city, state, county of birth, along with birth date)

D Final report card (and copy of transcript for grades 9-12) if entering at the beginning of the school

year; official withdrawal form or most recent report card (and copy of transcript for grades 9-12) if

entering during the school year.

E Mississippi Certificate of Compliance Immunization Form 121

School District-Representative Date

SHARED RESIDENCY ____ (See back for documentation

checklist.)

Shared Residency Verification Checklist

Items Needed for Shared Residency Verification: Items from all three categories (A, B, &

C) must be provided.

A. The homeowner must accompany the parent/guardian and provide the items

listed in A from previous page.

B. The parent/guardian must provide two (2) of the following items bearing the

address at which the student will be residing (PO Box is not acceptable):

__ Utility Bill

__ Automobile Registration (Affidavit will not be acceptable.)

__ Payroll Stub

__ Three (3) Significant Pieces of Mail (Bank statement, cell phone bill, Post

Office receipt for forwarded mail, etc.)

__ Government Mailing Communication

C. The parent/guardian must provide the completed Shared Residence Affidavit.

Senatobia Municipal School District

Shared Residency Verification

Items Needed for Shared Residency Verification: Items from all three categories (A, B, &

C) must be provided.

A. The homeowner must accompany the parent/guardian and provide the items

listed below.

(One document must be 1, 2 or 3, one must be #4, and one must be #5)

1. Filed Homestead Exemption Application Form

2. Mortgage Documents or Property Deed

3. Apartment or Home Lease (expiration date must be on lease and lease

should be on official letterhead and with phone number for contact person)

4. Utility Bills (water, gas, electric, cable) [Bill must be current—within 30 days

of residency verification.]

5. Automobile Registration (car tag receipt with name and physical address)

B. The parent/guardian must provide two (2) of the following items bearing the

address at which the student will be residing (PO Box is not acceptable):

__ Utility Bill

__ Automobile Registration (Affidavit will not be acceptable.)

__ Payroll Stub

__ Three (3) Significant Pieces of Mail (Bank statement, cell phone bill, Post

Office receipt for forwarded mail, etc.)

__ Government Mailing Communication

C. The parent/guardian must provide the completed Shared Residence Affidavit

(see attached).

D. Please provide the reason for the shared residency:

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

    Affidavit of Non-Ownership of Automobile

STATE OF MISSISSIPPI

COUNTY OF TATE

The undersigned, ___________________________, being duly sworn, hereby deposes

and says:

1. I am a resident of the Senatobia Municipal School District.

2. I do not have an automobile registered in Tate County because I do not

own a car or my car is registered in Tate County in someone else’s name.

I certify under penalty of perjury that I know the contents of this Affidavit signed by me

and that the statements are true and correct.

Executed this ________ day of ___________________, 20______.

_____________________________________________________

NAME

_____________________________________________________

ADDRESS

NOTARY ACKNOWLEDGEMENT

STATE OF MISSISSIPPI, COUNTY OF TATE,

_____________________________________

Notary Public

_____________________________________

Title

My commission expires __________________.

SENATOBIA MUNICIPAL SCHOOL DISTRICT LISTA DE VERIFICACIÓN DE RESIDENCIA Y

DOCUMENTACIÓN PARA EL AÑO ESCOLAR 2017-2018

(PARA SER COMPLETADO POR EL PADRE O GUARDIÁN LEGAL)

Nombre del Estudiante: ___________________________________________________ Grado: ________

Nombre del Padre / Guardián Legal:

Dirección del Padre, Guardián Legal: Tenga en cuenta que una casilla de correos no es aceptable como dirección de residencia

¿Está su hijo actualmente bajo suspensión o expulsión de otro distrito escolar? Sí ם No ם

Encuesta sobre el idioma

1. ¿Habla su hijo otro idioma que no sea el inglés? ( ) Sí ( ) No

2. En caso afirmativo, ¿cuál fue el primer idioma que su hijo aprendió a hablar?

3. ¿Qué idioma habla su hijo más a menudo? ______________________________________________________

4. ¿Es este niño un estudiante migrante? ( ) Sí ( ) No

5. ¿Es este niño un estudiante sin hogar? ( ) Sí ( ) No

6. ¿Es este niño un estudiante descuidado y / o delincuente? ( ) Sí ( ) No

7. ¿Tiene este niño alguna necesidad de discapacidad (SPED)? ( ) Sí ( ) No

En caso afirmativo, explíquelo por favor ________________________________________________________

8. ¿Necesita este niño servicios de habla? ( ) Sí ( ) No

9. ¿Está este niño en un programa dotado? ( ) Sí ( ) No

Por la presente certifico que la información dada arriba en este formulario es una declaración verdadera y correcta de mi residencia legal. Si mi residencia legal cambia mientras el estudiante mencionado arriba está inscrito en el distrito escolar arriba mencionado, notificaré inmediatamente a los oficiales apropiados de este distrito escolar. Además, entiendo que un alumno no está legalmente matriculado hasta que este formulario sea completado y firmado por el padre, guardián u otro adulto con quien el estudiante pueda estar viviendo. Entiendo que un alumno admitido bajo información falsa no está legalmente inscrito y está sujeto a pena.

Firma del Padre, Guardián Legal Fecha Número de teléfono

REQUISITOS DE RESIDENCIA

(PARA SER COMPLETADO POR EL DISTRITO ESCOLAR)

A Documentos que me proporcionaron los padres, guardiánes legales: (Un documento debe ser 1, 2 o 3, uno debe ser # 4, y uno debe ser # 5)

_____1. Formulario de Solicitud de Exención de Homestead

_____2. Documentos de hipoteca o escritura de propiedad

_____3. Apartamento o Arrendamiento de Vivienda (la fecha de vencimiento debe estar en el arrendamiento y el arriendo debe estar en el membrete oficial y con el número de teléfono para la persona de contacto)

_____4. Facturas de servicios públicos (agua, gas, electricidad, cable) [El proyecto de ley debe estar actualizado-dentro de los 30 días siguientes a la verificación de residencia.] _____5. Registro de automóvil (recibo de placa de coche con nombre y dirección física)

B El estudiante está viviendo con el guardián legal y una copia certificada del Decreto de la corte, o la petición si se recibió pendiente declarando que la tutela fue formada para un propósito distinto de establecer la residencia para los propósitos de la asistencia del distrito escolar.

C Se requiere un certificado de nacimiento certificado de todos los niños que se matriculen en el Distrito Escolar Municipal de Senatobia (incluye los nombres de los padres, ciudad, estado, condado de nacimiento, fecha de nacimiento)

D Tarjeta de informe final (y copia de la transcripción para los grados 9-12) si ingresa al principio del año escolar; El formulario de retiro oficial o el boletín de calificaciones más reciente (y copia de la transcripción para los grados 9-12) si ingresa durante el año escolar.

E Certificado de cumplimiento de Mississippi Formulario de inmunización 121

Representante del Distrito Escolar Fecha

RESIDENCIA COMPARTIDA

____ (Vea la página anterior

para la lista de verificación

de la documentación.)

Lista de verificación de la residencia compartida

Elementos necesarios para la verificación de residencia compartida: Se deben

proporcionar elementos de las tres categorías (A, B y C).

A. El dueño de la casa debe acompañar al padre / guardián y proveer los artículos

enumerados en A de la página anterior.

B. El padre / guardián debe proveer dos (2) de los siguientes artículos que llevan la

dirección en la cual el estudiante residirá (la casilla postal no es aceptable):

___ Cuentas de servicios públicos

___ Registro de automóvil (Declaración jurada no será aceptable.)

___ Talón de nómina

___ Tres (3) piezas de correo importantes (estado de cuenta bancaria, factura de

teléfono celular, recibo de correo postal para el correo reenviado, etc.)

___ Comunicación por correo del gobierno

C. El padre / guardián debe proveer la Declaración Compartida de Residencia

completa.