LPS Change of Information Form SCHOOL YEAR

Livonia Public Schools Change of Information Form

This form is for students already enrolled in LPS who need to change their address and/or contact information.
Person completing this form*

First NameLast Name
Email address (to confirm submission and contact for appointment)*
example@example.com
Which school does your child attend? (If you have students in multiple buildings, please choose the school of your oldest child.)

Student Information (Please list all students enrolled in the district.)*

	Full Name	Grade	Current School	Future School
Student 1
Student 2
Student 3
Student 4
Student 5
Student 6

Change(s) required:*

Change of addressLease updateUpdate to contact informationOther
Change of Information
Required Proof of New Address:
- Signed lease or closing papers; mortgage statement; tax bill; or, notarized shared housing documents, along with proof of residency from the home owner
- One piece of business mail, or an official change of address from the post office which reflects the new address
- Driver's License or State ID (for identification purposes only)
LPS will verify that the person(s) making the change is listed as parent/guardian on the student's record.
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 2 Name

First NameLast Name
Former Address (please enter N/A if you are not changing address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New Address (please enter N/A if you are not changing address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Change of Contact Information
New phone number 1 (please enter 0 if you are not changing phone number)*

Area CodePhone Number
New phone number is:*

HomeWorkCellN/A
New phone number is for:*

MotherFatherGuardianN/A
New phone number (father)
Please enter a valid phone number.
New phone number is:

HomeWorkCell
New phone number is for:

MotherFatherGuardian
New email address
example@example.com
New email is for:

MotherFatherGuardian
New email address
example@example.com
New email is for:

MotherFatherGuardian
Notes for LPS staff:
I affirm that the information provided is accurate. Any attempt to falsify information will result in withdrawal of the student(s), and the appropriate tuition charge will be assessed for each student(s) found to not be residents of Livoni Public Schools.
Signature*

Clear
Should be Empty:

Livonia Public Schools Change of Information Form

Change of Information

Change of Contact Information