Change of Address 2024-2025

The answer you give below will help the district determine what services you or your child may be able to receive under the McKinney-Vento Act. Students who are protected under the McKinney-Vento Act are entitled to immediate enrollment in school even if they don't have the documents normally needed, such as proof of residency, school records, immunization records, or birth certificate. Students who are protected under the McKinney-Vento Act may also be entitled to free transportation and other services.

Where is the student currently living? (Please check box if yes)

In permanent housingrequired

If the student is not living in permanent housing please visit Hicksville Public School's Administration Building located at 200 Division Avenue to pick up a paper packet if applying for Displaced/Homeless Status.

Are you a homeowner or renter/non-homowner?required

If the student is NOT living in permanent housing, proof of residency and other documents normally needed for enrollment are not required and the student is to be immediately enrolled. After the student has been enrolled, the district/school must contact the previous district/school attended to request the student's educational records, including immunization records, and the enrolling district's LEA liaison must help the student get any other necessary documents or immunizations.

Student Information

Suffix

Genderrequired

Existing Graderequired

Existing Schoolrequired

Previous Home/Residential Information

Staterequired

New Address

Staterequired

Is the student's mailing address different than the physical address listed above?required

Mailing Address

Staterequired

Contact Information

Parent/Guardian

Title

Relationship to Studentrequired

Emergency Contactrequired

Yes
No

Has custodyrequired

Yes
No

Can pick up studentrequired

Yes
No

Lives with studentrequired

Yes
No

Parent/Guardian Contact Information

Phone 1 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Phone 2 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Please do not enter duplicate phone numbers for contacts.

Contact 2 Information

Title

Relationship to Studentrequired

Emergency Contactrequired

Yes
No

Has custodyrequired

Yes
No

Can pick up studentrequired

Yes
No

Lives with studentrequired

Yes
No

Contact 2 Information

Phone 1 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Phone 2 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Please do not enter duplicate phone numbers for contacts.

Additional Family

Are there additional family members living at this address?required

Relationship to Studentrequired

Phone 1 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Phone 2 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Please do not enter duplicate phone numbers for contacts.

Add another family member?required

Relationship to Studentrequired

Phone 1 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Phone 2 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Please do not enter duplicate phone numbers for contacts.

Add another family member?required

Relationship to Studentrequired

Phone 1 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Phone 2 Typerequired

Preferred phone number?

Yes
No

Accepts SMS?

Yes
No

Please do not enter duplicate phone numbers for contacts.

Required Documents

Parent Photo ID

Please upload an acceptable form of documentation.required

Homeowner Proof of Residence

TWO (2) documents must be provided to verify residency. ONE (1) document from List A and ONE (1) document from List B.

List A: Provide ONE (1)ORIGINAL PROOF of the following:

House Title or Deed
Real Estate Closing Statement
Real Estate Closing Statement
Recent Mortgage Statement
Recent Nassau County School Tax Receipt
Recent Nassau County General Tax Receipt
Current Home Insurance Declaration Page

List B: Provide ONE (1) of the following:

Utility Bill
Bank Statement
Telephone Bill
Cell Phone Bill
Cable/Satellite Bill
Security System Bill
Credit Card Bill

Please upload a copy of an acceptable form of proof of residence from List Arequired

Please upload a copy of an acceptable form of proof of residence from List Brequired

Non-Homeowner/Renter Proof of Residence

Homeowner's Proof, Affidavit of Residency, Landlord Affidavit and TWO (2) documents from List B are required to verify residency.

Provide the following:

Copy of the Homeowner's current property tax bill, deed or mortgage statement.

Provide the following:

Notarized Affidavit of Residency

Provide the following:

Notarized Landlord Affidavit or valid executed Lease from Homeowner

List B: Provide TWO (2) of the following RECENT ORIGINAL proofs in the RENTER's NAME:

Utility Bill
Bank Statement
Telephone Bill
Cell Phone Bill
Cable/Satellite Bill
Security System Bill
Credit Card Bill

Please upload a copy of Homeowner’s current property tax bill, deed or mortgage statementrequired

Please upload a copy of the Landlord Affidavit or Leaserequired

Please upload a copy of the Affidavit of Residencyrequired

Please upload a copy of an acceptable form of proof of residence from List B (proof 1)required

Please upload a copy of an acceptable form of proof of residence from List B (proof 2)required

Electronic Signature

The electronic signature, and all of its related fields, replaces a handwritten signature on paper and is legally binding.

I affirm that the information provided is true, correct and complete, to the best of my knowledge and belief. This electronic signature below and its related fields are treated like a handwritten signature on a paper form.

Parent/Guardian Signature

I Agreerequired

McKinney-Vento Act

Student Information

Previous Home/Residential Information

New Address

Mailing Address

Contact Information

Parent/Guardian

Parent/Guardian Contact Information

Contact 2 Information

Contact 2 Information

Additional Family

Required Documents

Parent Photo ID

Homeowner Proof of Residence

Non-Homeowner/Renter Proof of Residence

Electronic Signature

Parent/Guardian Signature

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