In the educational journey of every student, there are various forms and documents that play crucial roles, and among them, the Cobb County School District Form JF-11, also known as the Non-Parental Affidavit, stands out for its unique purpose. This form is specifically designed for situations where a child is residing in the Cobb County School District but not under the care of their parents or legal guardians. The person with whom the student is living, who must be an adult, is required to complete this form, providing detailed information including their personal details, the reasons behind the student’s living situation, and the last known details about the student’s parent(s) or legal guardian. Its primary aim is to facilitate the student’s continued education within the district by ensuring all legal and situational details are clearly documented. Importantly, the form also contains several attestations the signer must agree to, regarding the authenticity of the information provided, the commitment to the student’s education, and a clear stance that the enrollment request is not for the sake of attending a specific school for reasons unrelated to academics, such as athletics or special programs. It also underscores severe legal repercussions for any falsification of information or fraud, highlighting the importance of honesty and accuracy in completing the affidavit. With the potential penalties including fines and imprisonment for forgery or making false statements, the form serves a significant function in maintaining the integrity of the educational system and ensuring students in unique living situations receive the education they are entitled to without undue manipulation of the system.
| Question | Answer |
|---|---|
| Form Name | Form Jf 11 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | initialing, 2012, jf 11 cobb county, jf 11 form |
Cobb County School District |
Form |
Empowering Dreams for the Future |
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This form must be fully completed.
Please Print or Type
THIS FORM SHALL BE COMPLETED BY AN ADULT WITH WHOM THE STUDENT IS LIVING.
This form shall be completed for students living in the Cobb County School District (District) who do not live in the home of their parents or guardian.
I, the undersigned, am over eighteen (18) years of age and competent to testify to the facts and matters set forth herein.
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1.Reason the student is living with the
A.The death, serious illness, or incarceration of a parent or legal guardian.
B.The abandonment by a parent or legal guardian of the complete control of the student as evidenced by the failure to provide substantial financial support and parental guidance.
C.Abuse or neglect by the parent or legal guardian.
D.The physical or mental condition of the parent or legal guardian is such that he or she cannot provide adequate care and supervision of the student.
E.The loss or inhabitability of the student’s home as the result of a natural disaster.
F.The parent or guardian is unable to provide care and supervision of the student because he or she is serving in the military.
G.The student is living in a foster home, group home, or other institution or care facility that is located in the county.
H.The parents cannot be located.
2.The name and last known address of the child’s parent(s) or guardian is:
3.I assumed control and charge of this student, which I provide 24 hours per day and 7 days per week, on _________________. (day/month/year)
4.The name and address of the last school that the child attended is:
5.The School District’s Superintendent, or his/her designee, may verify the facts contained in this affidavit and conduct an audit on a
6.I attest that this request to attend the Cobb County School District is not primarily related to attendance at a particular school in the Cobb County School District nor is this affidavit being completed for the purpose of participating in athletics at a particular school, taking advantage of special services or programs offered at a particular school, or for any other similar purpose.
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7.I further attest that the student named above is not now under a
8.I further attest that I have been given the responsibility for educational decisions for the student including, but not limited to, receiving notices of discipline, attending conferences with school personnel, granting permission for school related activities, and taking appropriate action in connection with student records.
9.If the parent, guardian, or legal custodian is unable, refuses or is otherwise unavailable to sign this form, I have made every effort to secure that signature.
10.I understand that if any of the information provided on this affidavit is changed for any reason, it is my responsibility to immediately notify the Cobb County School District.
NOTICE OF PENALITIES AND LIABILITY:
I understand that:
1.If I falsify information or defraud the Cobb County School District on this affidavit, I will be obligated to pay for the costs incurred by the District for the period during which the ineligible student is enrolled, and shall remunerate the District as set forth in O.C.G.A. §
2.If the costs incurred by the District are collected by an attorney, I will be obligated to pay for all expenses and attorney’s fees incurred by the Board of Education in the collection of same.
3.I may be prosecuted, held criminally liable, and imprisoned for not less than one nor more than ten years if I am found guilty of forgery in the first degree, pursuant to O.C.G.A. §
4.I may be prosecuted, held criminally liable, and imprisoned for not less than one nor more than five years if I am found guilty of forgery in the second degree, pursuant to O.C.G.A. §
5.I may be prosecuted, held criminally liable, and punished by a fine of not more than $1,000.00 or by imprisonment for not more than one nor more than five years, or both, if I am found guilty of making false statements pursuant to O.C.G.A. §
6.I may be prosecuted, held criminally liable, and punished by a fine of not more than $1,000.00 or by imprisonment for not less than one nor more than five years, or both, if I am found guilty of false swearing pursuant to O.C.G.A. §
7.By initialing on the lines provided next to each of the items listed above, I affirm that I have read and understand each of these provisions.
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I SOLEMNLY AFFIRM UNDER THE PENALTIES LISTED ABOVE THAT THE CONTENTS OF THIS AFFIDAVIT
ARE TRUE TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.
Signature of affiant (adult with whom the child is living)
Signature of parent/guardian
PLEASE NOTARIZE
Sworn to and subscribed before me this ______day of
________, 20____.
Notary Public:__________________________________
Name of Affiant (Adult with whom the child is living)
(Please Print):____________________________________________
Enrolling Person Signature:
________________________________________________________
Principal/Designee Signature: _______________________________
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