The St. Johnsbury School District
“…supporting respectful, caring, lifelong learners…”
Dr. Nicole Saginor, Superintendent/Director of Curriculum, Instruction and Assessment
Marion Anastasia, Principal
Dwayne Before, Associate Principal
Deb Sanders-Dame, Interim Director of Student Support Services
(Phone) 802-748-8912
www.stjsd.org
(FAX) 802-748-1095
Declaration of Residency
Town of St. Johnsbury
I the undersigned am the parent and/or legal guardian of the child whose name follows:
____________________________________________________________________
I, hereby, declare that I am a legal resident of the Town of St. Johnsbury and that, therefore,
my children are entitled to be educated in approved elementary and secondary schools at the
expense of the St. Johnsbury School District. My St. Johnsbury mailing address is:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
The location of my residence is (list street/road, nearest neighbor, etc):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Parent/Guardian’s Name (Please Print):______________________________________________________________
Parent/Guardian’s Phone Number: _________________________________/__________________________________
Home
Work
I hereby attest that all the above information is true and accurate.
_________________________________________________________________
Signature of Parent/Guardian
___________________________
Date
Please attach a copy of your lease agreement, purchase/sales agreement, property tax bill,
CVPS or Charter Communication bill.
Note: Please be aware that Title 13, Section 3016, Vermont Statutes Annotated calls for
penalties of up to five years in prison and a fine of $10,000 for a “false claim.”
257 Western Avenue
St. Johnsbury, VT 05819