THIS IS INTENDED TO SERVE AS A SAMPLE FORM IN AN APPEAL INVOLVING RESIDENCY. THE PARTICULAR ALLEGATIONS WILL VARY DEPENDING ON THE NATURE OF THE APPEAL. THIS FORM IS FOR GUIDANCE ONLY.
STATE OF NEW YORK
STATE EDUCATION DEPARTMENT
In the Matter of (PETITIONER'S NAME),
on behalf of (CHILD'S NAME) from
action of the Board of Education
of the ______________ School
District regarding the denial of
admission on the basis of residency.
TO THE COMMISSIONER OF EDUCATION:
1. My name is _______________and I reside at
_______________within the School District.
2. My relationship to (child's name) is _______________.
3. (Child's name) resides at (address), within the _______________ School District.
4. (Child's name) has resided within the _______________ School District for (length of time).
5. (Child's name) intends to reside at (address) for (length of time).
6. (Child's name) resides with (parent, guardian, self, etc.) at (address).
7. Provide a statement of any other location (s) where the child lives. Indicate the length of time the child is at the other address and provide an explanation. If the child does not live at any other address, indicate that.
IF THE CHILD LIVES WITH SOMEONE OTHER THAN HIS/HER PARENTS OR LEGAL GUARDIAN BUT IS NOT AN EMANCIPATED MINOR, COMPLETE PARAGRAPHS 8-11.
8. State the reason the child is not living with a parent or legal guardian.
9. (Name of appropriate individual) is supporting ( child's name) and provides food, shelter, and clothing.
10. (Name of appropriate individual) exercises control over (child's name) activities and behavior.
11. (Child's name) parent (s) has/has not (circle one) surrendered parental control over (child's name) to (appropriate individual).
IF THE CHILD IS OVER 16 AND SELF SUPPORTING, COMPLETE PARAGRAPH 12.
12. (Child's name) was born on (date of birth) and is over the compulsory school age. (if contested, provide proof of age as an exhibit.)
13. Statement describing how the child is supporting himself/herself (attach separate page if necessary). (If contested, attach proof of means of support [i.e., pay stub, letter from the Department of Social Services, etc.].)
14. (Child's name) is over five and under twenty-one years of age and has/has not (circle one) received a high school diploma.
15. Statement describing the nature of child's relationship with parents, i.e., last contact, frequency and nature of contacts, parents' whereabouts, etc..
16. Statement describing approximate date and reasons the child began living apart from parents.
17. On (date), (child's name) made a request for admission to the School District.
18. (Child's name)'s request was denied by respondent on (date).
19. (Child's name) has not been attending school or receiving any educational services since (date).
20. (Child's name) has been attending school since (date).
WHEREFORE, ____________________ respectfully requests:
1. Interim relief permitting (child's name) to attend the ________________ school district pending a decision on the merits of this appeal, and
2. A determination that (child's name) is a resident of the _______________ school district and is entitled to attend school district without the payment of tuition.
3. Such other relief as the Commissioner deems just and proper.
ATTACH ANY SUPPORTING AFFIDAVITS AND EXHIBITS.