To Residency: _________________
From Residency: _______________
CERTIFICATE OF RESIDENCY
(Indicate School Year)
(Please read carefully before completing)

When a student and the parent or guardian are living in a dwelling that is rented or owned and occupied by a legal
East Hartford resident, the person who owns or rents the dwelling (called the Host hereafter), must complete the
Certificate of Residency form.

Board of Education Policy requires both the Host and the parent or guardian, or student if eighteen (18) or older, to
present proof of residency in East Hartford during the school registration process.

The Host must present to Central Registration, three (3) proofs confirming residency in East Hartford, the parent or
guardian, or the student if eighteen (18) or older, must also present two (2) documents confirming residency in East
Hartford, see page 3 for examples.

By law, the burden of proving residency to attend East Hartford Public Schools falls on the parent or guardian, or
student if eighteen (18) or older, not East Hartford Public Schools.

All students attending East Hartford Public Schools under a Certificate of Residency are subject to residency
investigations which may include unannounced residency visits and surveillance at any time.

All Certificates of Residency expire on the last day of school for the current school year. For continued enrollment
for the following school year, the parents, guardians or student if eighteen years (18) or older, and the student’s Host
must complete a Certificate of Residency Renewal if the student continues to live with the Host. Non-compliance
with the Certificate of Residency Renewal may result in:
o Possible withdrawal from school
o Cancellation of transportation (if provided by the District)
o
Residency investigation/surveillance
If any student is found to be attending East Hartford Public Schools illegally; the student will be subject to
withdrawal from school. Furthermore, the Town of East Hartford reserves the right to recover the costs of such
education from the Hosts, parents, guardians or student if eighteen years (18) or older.


All Certificates of Residency are reviewed by the East Hartford Public Schools Registration staff. Please Note: forms
that are incomplete or not properly filled out will be returned which may delay student’s entry into school.

To assure that all school mail is received for the student and not returned to the post office; include your name on
the mailbox of your current residence.

For more information pertaining to school residency, visit www.easthartford.org
*****RESIDENCY OFFICER’S REVIEW*****
Residency Investigator’s Signature: ______________________________________ Date: _____________
LexisNexis Accurint Address Verification: ____________________________________________________
Date Visit Made: ____________________________ Expiration Date: ______________________________
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1
CONFIDENTIAL
CERTIFICATE OF RESIDENCY
Please Note: Forms will be returned if not completed properly
As part of our residency verification process, we are requesting that you as the owner/tenant of the residence
in East Hartford verify that:
Name of Student(s):
and Student(s) Parent/Guardian:
___ reside with
.
me at
Address, Phone, Apt/Unit #, Town
I,
certify that the above named student(s) and
Host (Local Resident, Relative, etc).
parent(s)/guardian(s) reside with me at the above listed address seven (7) days a week, in a residence owned or
occupied by me in the Town of East Hartford. I realize that if I make a false statement as to residency, I may be held
liable for a share of the cost for the education of the said student(s) if they, in fact, do not reside in East Hartford.
I understand that a Certificate of Residency is only valid for the current school year and must be renewed annually.
I hereby give consent to the Residency Officer to investigate or obtain any information pertaining to my permanent
residency (address). This may include a check with prior addresses to verify move, homeowners, landlords, case
workers, and utilities, government agencies, housing agencies or any other agencies regarding my permanent
residence.
I agree to notify the school immediately regarding the termination of the student’s full time physical presence
(permanent residency), in the Town of East Hartford in which event the student will no longer be eligible for free
school privileges. Finally, I understand that should the student be found to be attending East Hartford Public
Schools illegally, the student will be immediately withdrawn and the Town of East Hartford reserves the right to
recover the costs of such education from me, the undersigned and or the legal guardian of students listed above.
I understand that a perjured or fraudulent statement may lead to the immediate disenrollment of the above-named
student(s).
*****MUST BE SIGNED IN THE PRESENCE OF NOTARY PUBLIC OFFICIAL*****
Signed:
Date:
Host (East Hartford Legal Resident)
Signed:
Date:
Parent/Guardian of Student or Student if eighteen (18) or older
Signed:
Date:
Notary Public Signature and Stamp
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Proof of residency to enter into any East Hartford school is determined
by the Host providing a Central Registration staff member with one
MANDATORY item from Category A, one MANDATORY item from
Category B and one MANDATORY item from Category C.
For a total of three (3) items.
The Parent/Guardian must also provide a Central Registration staff
member with two (2) items from any of the categories below.
RESIDENCY DOCUMENTS SUBMITTED ARE REQUIRED TO BE LESS
THAN 60 DAYS OLD AND REFLECT CURRENT ADDRESS.
SHUT OFF NOTICES WILL NOT BE ACCEPTED.
CATEGORY A





Current Mortgage
statement and/or
Mortgage coupon
book
Copy of current
lease signed &
dated
Legal affidavit from
landlord affirming
tenancy and copy of
current rent
payment. Affidavits
are available from
the staff in Central
Registration
Section 8 agreement
Copy of property
deed if no mortgage
CATEGORY B






Current utility bill
or work order
showing service
address not
older than 60
days:
Home Fuel: Gas,
Oil or Propane
Electric
Phone (landline
only)
Cable TV, Direct
TV or Satellite TV
Water
CATEGORY C

















Second utility bill from list in Category B
Valid driver’s license with current address (no
stickers allowed)
Valid automobile registration
Valid CT DMV non-driver’s photo identification
Voter registration
Cell Phone Bill (not older than 60 days)
Auto tax bill
Property tax bill
Current Homeowner’s or auto insurance policy
face page
Current payroll stub
Current bank statement or credit card statement
Court document
Current letter from a government agency-military,
Social Security, etc.
Change of Address Card from U.S. Post Office
Delivery Receipt
Storage Bill
Any other form of documentation relevant to
demonstrating entitlement to attend EHPS.
Forms subject to Residency Staff approval.
Note: Self- addressed envelopes; advertisements and junk mail are not acceptable forms of
residency documents. If you don’t pay for your utilities separately, we will work with you to
find acceptable documents necessary to establish residency.
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