CHANGE OF ADDRESS FORM

Please complete this form to change your address.

Please include all BPS students in your household. Enter each child only once.

PARENT/GUARDIAN

First NameLast Name

TELEPHONE

EMAIL

example@example.com

NEW Address

Street Address

Street Address Line 2

CityState

Zip Code

Click here for a listing of STREETS & SCHOOL ZONES

Students moving to a new address within their zone may continue attending their current school.

NEW SCHOOL ZONE

NE= NORTH EAST NW= NORTHWEST S= SOUTH CW=CITYWIDE

Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Click here for a listing of STREETS & SCHOOL ZONES

PREVIOUS SCHOOL ZONE

NE= NORTH EAST NW= NORTHWEST S= SOUTH CW=CITYWIDE

STUDENT'S NAME *

First NameLast Name

DATE OF BIRTH

MONTH/DAY/YEAR

CURRENT SCHOOL

GRADE

STUDENT ID#

SIX DIGIT LUNCH NUMBER

DESIRED SCHOOL CHOICES (if moved to a new zone):

SCHOOL CHOICE 1

SCHOOL CHOICE 2

SCHOOL CHOICE 3

Do you have more than one child attending BPS?*

YESNO

STUDENT'S NAME #2 only complete if you have more than one child

First NameLast Name

DATE OF BIRTH

MONTH/DAY/YEAR

CURRENT SCHOOL

GRADE

STUDENT ID#

SIX DIGIT LUNCH NUMBER

DESIRED SCHOOL CHOICES (if moving to a new zone):

SCHOOL CHOICE 1

SCHOOL CHOICE 2

SCHOOL CHOICE 3

STUDENT'S NAME #3

First NameLast Name

DATE OF BIRTH

MONTH/DAY/YEAR

CURRENT SCHOOL

GRADE

STUDENT ID#

SIX DIGIT LUNCH NUMBER

DESIRED SCHOOL CHOICES (if moving to a new zone):

SCHOOL CHOICE 1

SCHOOL CHOICE 2

SCHOOL CHOICE 3

STUDENT'S NAME #4

First NameLast Name

DATE OF BIRTH

MONTH/DAY/YEAR

CURRENT SCHOOL

GRADE

STUDENT ID#

SIX DIGIT LUNCH NUMBER

SCHOOL CHOICE 1

SCHOOL CHOICE 2

SCHOOL CHOICE 3

Signature

Clear

UPLOAD PROOF OF RESIDENCY*

You will be required to submit proof of residency (recent utility bill - gas, electric or cable, lease or mortgage statement) along with this form. Your name, address and date must be visible on your bill.

BY DIRECT UPLOAD

BY EMAIL: studentrecords@bpsma.org

BY FAX: 508.580.7956

BY TEXT: 774.297.3627

IN PERSON: School Registration & Parent Information Center
60 Crescent Street Brockton, MA 02301
(document drop off window at the rear of the building)