• Pewamo-Westphalia Community Schools

    5101 Clintonia Rd. Westphalia, MI 48894 * 989.587.5100

  • Certified Birth Certificate and Proof of Residency

    Please print this form and submit with original copies. Fill out only the student name and date of birth; office staff will fill out the rest of the form.
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    Pick a Date

  • Certified birth certificate verification

    Office: make copy and file in CA-60

    Office Use:

    1. ___ Certified birth certificate
    2. ___ Hospital issued birth certificate
    3. ___ Passport
    4. ___ Visa
    5. ___ Other* ______________________________________________________

    * Attached to notarized statement explaining absence of cetified copy of birth certificate.

     

    Signed: _____________________________________________________________

     

    Date: ______________________

  • Residency Verification

    Office: make copy and file in CA-60

    Parent/Guardian must provide the school with Proof of Residency.

    Office use:

    1. ___ Property tax assessment/bill
    2. ___ Utility bill
    3. ___ Telephone bill
    4. ___ Insurance statement
    5. ___ Personal home visit
    6. ___ Medical assistance authorization
    7. ___ Cable bill
    8. ___ Lease
    9. ___ Mortgage statement
    10. ___ Other ____________________________________________

     

    Signed:__________________________________________________

     

    Date: ___________________

  • Should be Empty: