Indiana Universal Choice Scholarship Proof of Residency Form as of May 7

Brebeuf Jesuit Indiana Universal Choice Scholarship Proof of Residency Form

The State of Indiana requires that Brebeuf Jesuit Preparatory School prepare and submit the Indiana Choice Scholarship Application on your behalf. This requires all applicants to prove residency in the state of Indiana. The proof of residency must contain an address that is current and correct.
Student Information
Student Name

First NameMiddle NameLast Name
Student Birth Date

MonthDayYear
Date
Student Grade Level as of 2026-27 School Year
Student Residence Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Information
Name of Parent/Guardian Completing Form

First NameLast Name
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: 000-000-0000.
Proof of Residency
In the form field below, please upload/attach your proof of residency.

The proof of residency must contain an address that is current and correct and may be provided by submitting one of the following items:
- Driver's license/State ID of parent/guardian completing form
- Utility bill within the last 90 days
- Current lease agreement or mortgage statement
- 1040 within the last two years
PDFs are preferred.

Please name/save your file in this format: Student Last Name - Student First Name

File Name Example: Smith-John.pdf
Upload Proof of Residency (PDF Preferred)

Cancelof
Should be Empty:

Brebeuf Jesuit Indiana Universal Choice Scholarship Proof of Residency Form