PDF FLORIDA DEPARTMENT OF EDUCATION - School Choice
FLORIDA DEPARTMENT OF EDUCATION
OFFICE OF INDEPENDENT EDUCATION AND PARENTAL CHOICE
MCKAY SCHOLARSHIP PROGRAM
GUARDIAN ISSUE FORM
1) To change parent/guardian information, please provide the following information and attach the documentation indicated on page 2.
2) Fax this completed form and accompanying documents to your Regional Manager.
Student's Name: Previous Parent/Guardian Information:
First Name: Signature: SSN: New Parent/Guardian Information: First Name: Street: City, Zip: SSN: Reason for the change:
Date of Birth:
Last Name:
Date:
Last Name: Phone: Email: Date:
* Signature: * Private School Information:
School Name: School Contact: Phone number: Contact Signature:
County:
School Code: Date:
* This information is REQUIRED in order to complete the change request.
Rev.2/07/19
325 W. GAINES STREET ? SUITE 1044 ? TALLAHASSEE, FL 32399-0400 ? (800) 447-1636 ? Fax (850) 245-0875
MCKAY GUARDIAN ISSUE FORM
PAGE 2
Please indicate the reason for your change request. You must provide a copy of the documentation listed below to verify the reason for change.
Reason for Change
Parent/guardian change of name due to
change in marital status
Parent/guardian change of name due to
deceased spouse
Change in guardian
Parent/guardian unable to sign
Child moved to group home
Foster parent
Change in parent signing (for convenience)
Other _________________________
Required Documentation
Marriage certificate/divorce decree Social Security card with new legal name Parent Affidavit
Death certificate Social Security card of new guardian Parent Affidavit
Court documentation Social Security card of new guardian Parent Affidavit
Power of Attorney (POA holder may not be the school or any school staff.)
Social Security card of POA holder Parent Affidavit
Power of Attorney (POA holder may not be the school or any school staff.)
Parent/guardian Social Security card Parent Affidavit
Court documentation Foster parent/guardian Social Security card Parent Affidavit
Letter requesting the change signed by both parents
Social Security card of new parent Parent Affidavit
Consult your Regional Manager
Fax, mail, or email the completed Guardian Issue Form (both pages) and accompanying documentation to the attention of your Regional Manager.
Fax: 850-245-0875 Email: Schoolchoice@
Mail:
Office of Independent Education and Parental Choice 325 W. Gaines Street, Room 1044 Tallahassee, FL 32399-0400
Rev.2/07/19 325 W. GAINES STREET ? SUITE 1044 ? TALLAHASSEE, FL 32399-0400 ? (800) 447-1636 ? Fax (850) 245-0875
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