Form II DOE at a glance
What it is: Form II DOE, the Custodial Statement and Agreement: Third-Party Custody, is prepared by the State Superintendent of Public Instruction as required by I.C. 20-26-11-3.
Who signs: The parent and the guardian each enter a Name (printed) and a Date and sign on a Signature line.
A filled-in Form II DOE example: a guardian takes custody of a student
How to fill out Form II DOE, box by box
Student Information
Under Student Information, enter the Name (last, first, mi), the street, city, state and zip code, the Last school corporation attended and the Current school corporation.
Reason for utilization of this form
Indicate the reason for utilization of this form: The student has been abandoned.
Indicate the reason for utilization of this form: The parents are unable to support the student and the student is living with the guardian or custodian, who is supporting and caring for the student. The student was not placed with the guardian or custodian for the primary purpose of attending school in the school corporation of the guardian's or custodian's residence.
Indicate the reason for utilization of this form: The parents are living outside the United States and maintain no home in any school corporation.
Parent Information
Under Parent Information, enter the Name (last, first, mi), street, city, state and zip code.
Guardian or Custodian Information
Under Guardian or Custodian Information, enter the Name (last, first, mi), street, city, state and zip code of the person with whom student will live.
The guardian or custodian, the person with whom student will live, agrees to assume all the duties and be subject to all the liabilities of the parent of the student with respect to dealing with the school corporation and for all other purposes under Indiana Code 20-26.
Signing and acknowledgement
The parent and the guardian each enter a Name (printed) and a Date and sign on a Signature line.
"I affirm, under the penalties for perjury, that the foregoing representations are true."
Acknowledged by (name and title) on behalf of (school corporation), with a Date.
More rules for Form II DOE
This agreement is binding from the date signed until terminated by the parent or guardian in writing.
Sources
[1] Form II DOE (11/17), Custodial Statement and Agreement: Third-Party Custody, Indiana Department of Education (the Official source link on this page).