(Request for Waiver)


In cases where a student living in the district wishes to register and such student is not able to provide proof that the student is domiciled in the district, the student, parent, military guardian, legal guardian or person acting as a parent must request a waiver of proof of residency. Waiver of proof of residency may only be granted on the basis of hardship or good cause. Under no circumstances shall athletic ability be a valid basis of hardship or good cause for the issuance of a waiver. The Board or a committee of the Board may convene a hearing to consider the request as soon as possible, but no later than 45 days after the receipt of the waiver request, or else the waiver shall be granted.


Student Information


Student's Name:


Name of Parents/Court-appointed Legal Guardians/Military Guardians:

Address of Parents/Court-appointed Legal Guardian/Military Guardian:

Person Acting as a Parent:

Address of Person Acting as a Parent:

Reason Student Is Living in the District:


Signature of Student, Parent, Military Guardian, Legal Guardian or Person Acting as a Parent





According to 167.020, RSMo., any person who knowingly submits false information to satisfy the residency requirements shall be subject to class A misdemeanor charges and may be civilly liable for expenses incurred while the student was enrolled.


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Note: The reader is encouraged to review policies and/or procedures for related information in this administrative area.


Implemented: 05/13/04


Revised: 10/13/05


Advance School District R-IV, Advance, Missouri