Skip to content
201 Glenwood-Dyer Road
Glenwood, IL 60425
708 758 5190
District Office
info@brookwood167.org
District Email
About
167 School Board
COVID-19 Dashboard
District Report Cards
Freedom of Information Act (FOIA)
Mission & Vision
Contact Us
Schools
Brookwood Junior High School
Brookwood Middle School
Hickory Bend Elementary School
Longwood Elementary School
Departments
Curriculum & Instruction
Food Service
Technology
Resources
Attendance & Truancy
Bullying, Intimidation & Sexual Harassment
CHAMPIONS
Crisis Go
ESSER Funds
Grievance Procedures
Lockdown/Active Shooter Drill
Medical Forms
PAPER Student Tutoring
Parent/Student Handbook
PowerSchool
Read 180 – Next Generation
Return-To-Learn & Continuing Services
Section 504 Services
Sexual Health Curriculum
Staff Directory
Student Online Personal Protection Act (SOPPA)
Administration
Business Office
Employment Opportunities
HR Classroom
Office of the Superintendent
Crisis Response Plan
Threat Assessment
Blog
Calendar
Menu
About
167 School Board
COVID-19 Dashboard
District Report Cards
Freedom of Information Act (FOIA)
Mission & Vision
Contact Us
Schools
Brookwood Junior High School
Brookwood Middle School
Hickory Bend Elementary School
Longwood Elementary School
Departments
Curriculum & Instruction
Food Service
Technology
Resources
Attendance & Truancy
Bullying, Intimidation & Sexual Harassment
CHAMPIONS
Crisis Go
ESSER Funds
Grievance Procedures
Lockdown/Active Shooter Drill
Medical Forms
PAPER Student Tutoring
Parent/Student Handbook
PowerSchool
Read 180 – Next Generation
Return-To-Learn & Continuing Services
Section 504 Services
Sexual Health Curriculum
Staff Directory
Student Online Personal Protection Act (SOPPA)
Administration
Business Office
Employment Opportunities
HR Classroom
Office of the Superintendent
Crisis Response Plan
Threat Assessment
Blog
Calendar
residency
Student’s Name (Please use the student’s legal name as it appears on their birth certificate)
Powerschool ID
Student First Name
Student Middle Name
Student Last Name
Student Information
Date of Birth
Gender
Please Select...
Male
Female
Grade
Please Select...
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
IEP (Individualized Educational Plan)
Yes
No
504 Plan
Yes
No
With whom does the student(s) reside?
First Name
Last Name
Relationship
Please Select...
Grandmother
Grandfather
Godfather
Godmother
Family Friend
Aunt
Uncle
Cousin
Brother
Sister
Niece
Nephew
Mother
Father
Parent
Addr1
Addr2
City
State
Zip
Best Daytime Phone #
Email
I affirm that the information presented in this verification form, in connection with any investigation of my residency or the residency and custody of the student, is true, complete and accurate.
I understand that knowingly or willfully providing false information to the school district regarding the residency of a child for the purpose of enabling that child to attend any school in that district without the payment of nonresident tuition is a Class C misdemeanor.
I understand that knowingly enrolling or attempting to enroll a child in the school of a school district on a tuition-free basis when I know the child to be a nonresident of the school district, unless the nonresident child has a lawful right to attend, is a Class C misdemeanor and I will be liable for payment of tuition, fees, and all other applicable fines.
I certify to the best of my knowledge that the above information is true and accurate. I understand that if my residency is in question, I may be investigated.
submit the form
