School Board of Brevard County, Florida EDUCATIONAL GUARDIANSHIP AFFIDAVIT
INSTRUCTIONS: If you are not the parent/legal guardian or a student, one (1) of the following documents must be provided for enrollment: (1) Court Order governing custody, (2) Department of Children and Families’ Placement Letter, or (3) Educational guardianship Affidavit. This Educational Guardianship Affidavit shall only be used when a parent/legal guardian lives outside of Brevard County, Florida and adjacent counties and wishes to enroll a student. This shall not be used to circumvent School Board Policy 7120 Criteria for Balancing School Membership to Capacity and/or Policy 5120 Assignment Within District, which govern student assignment/enrollment and the execution of this Educational Guardianship Affidavit does not violate the intent of such assignment policies.
AFFIDAVIT OF APPLICANT FOR EDUCATIONAL GUARDIANSHIP:
I am eighteen (18) years of age or older and have agreed to fulfill the role of caregiver for the student named below.
1. Name of student: ______________________________________________________________
2. Student’s date of birth: ________________________________________________________
3. Check one or both statements if applicable below:
_____ I have advised the parent(s) or other person(s) having legal custody of the student as to my intent to authorize any and all legal matters necessary for the custody and education
of said student and have received no objection.
_____ I am unable to contact the parent(s) or legal guardian(s) at this time to notify them of my intended authorization.
FURTHER AFFIANT SAYETH NAUGHT.
Section 837.06, Florida Statutes, provides that “whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.” A student whose parent(s)/legal guardian(s)/affiant(s) who falsifies address information or uses this Educational Guardianship Affidavit to circumvent enrollment at the zoned school will be withdrawn and required to enroll at the zoned school. Said student may forfeit any future opportunity to attend a school other than his/her zoned school.
BEFORE ME, the undersigned authority, personally appeared _______________________ (hereinafter “Affiant”) who, being by me first duly sworn, says:
1. Affiant’s name is ______________________________________.
2. Affiant’s identifying information is as follows:
Date of Birth: _______________________________
Address: _______________________________
________________________________
3. The copy of Affiant’s driver’s license, attached hereto is a true and correct copy of such identification.
AFFIANT’S SIGNATURE: ________________________________________
AFFIANT’S PRINTED NAME: _____________________________________
COUNTY OF BREVARD STATE OF FLORIDA
SWORN TO AND SUBSCRIBED BEFORE ME this ______ day of ______________, 20______, by ___________________________, who is personally known to me OR has produced _________________________ as identification.
(SEAL) __________________________________________________________
NOTARY PUBLIC
STATE OF FLORIDA AT LARGE
