Sample Template for Use by Schools

***Ask the school to use this template on the school’s letterhead and  input the needed information to replace the guidelines in the brackets <> and the brackets***


<Insert Today's Date>

<Insert Parent/Guardian’s Name and Address>

Re: <Insert Child's Name>

To Whom It May Concern:

According to our records, <Child's Name> attended <Name of School> during the <Insert the Months the Student Attended during the Year on the Notice>. Our records reflect that the student lived at <Street Address, City, State, and Zip Code (if the child moved during the year, put all listed addresses> during this time.

Our records also reflect that the student's parent or guardian during this time was <Insert Parent's or Guardian’s Name(s)>. The student's parent's or guardian's address of record during this time was listed as <Insert Parent's or Guardian’s Address(es)>.


<Insert Signature of School Official>
<Insert Name of School Official>
<Insert Title of School Official>
<Insert Phone Number of School Official>