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5151E.1- Affidavit Emancptd Stud.doc
Handle: Document-12561
Owner: TeWinkle, Coralie (User-2641, ctewinkl:DocuShare)DS
Wednesday, January 16, 2002 04:53:46 PM EST
Wednesday, January 16, 2002 04:53:46 PM EST
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  • Exhibit 5151 E-1
Page 1 of 2WAYNE CENTRAL SCHOOL DISTRICT ● Ontario Center, New York 14520RESIDENCY AFFIDAVIT OF EMANCIPATED STUDENTSTATE NEW YORK (COUNTY OF WAYNE (TOWN OF…………… (I, the undersigned being duly sworn, depose and say that the information provided herein is true and complete to the best of my knowledge:Name………………………………………………………………………………………Date & Place of Birth……………………………………………………………………..
  • Grade (20 …-….) ……………………..
  • Age ……………………………………..
  • Present Full-Time Address: …………………………………………………………..
  • ………………………………………………………………………………
5) Name(s) & Address(es) of Parent(s): ……………………………………………………………………………………………… ………………………………………………………………………………………………Date on w...
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5151E.1- Affidavit Emancptd Stud.doc
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Appears In: WCSD District Policy Handbook
Preferred Version: 5151E.1- Affidavit Emancptd Stud.doc