CERTIFICATION OF STUDENT STATUS

Head of Household:Unit Number:

Please complete one form per household.

Check A, B, or C, as applicable. Only one box should be checked for a household

Please note that students include those attending public or private elementary schools, middle or junior high schools, colleges, universities, technical, trade, or mechanical schools; however, it does not include those attending on-the-job training courses.

A.Household contains at least one occupant who is not a student and has not been or will not be a student for

five (5) months or more out of the current and/or upcoming calendar year (months need not be consecutive).

B.Household contains all students, but is qualified because the following occupant(s) , is/are PART TIME student(s). Verification of part time student status is required for at least one occupant.

C.Household contains all FULL TIME students for five (5) months or more out of the current and/orupcoming calendar year (months need not be consecutive). If this is true, one of thefive exceptions below must be met:

At least one member of the household was previously under foster care. (Mgmt: Attach verification of participation from DSS/Human Services)

At least one member of the household receives assistance under Title IV of the Social Security Act, i.e. TANF payments. (Mgmt: Attach a verification from the agency administering the grant)

At least one member of the household is currently enrolled in a job-training program that receives assistance under the Job Training Partnerships Act (JTPA) or is funded by a state or local public agency. (Mgmt: Attach a verification from the agency administering the program)

The head of household is a single parent with child(ren) and the parent is not a dependent of anyone else and the child(ren) is/are not dependent(s) of someone other than a parent. (Mgmt: Attach a copy of the most recent signed tax return reflecting the dependent status)

All members of the household are married and eligible to file a joint federal tax return. (Mgmt: Attach a copy of the couple's actual marriage certificate or a signed copy of their latest joint income tax return)

Full-time student households which do not meet one of the above exceptions or the verification does not support the exception indicated are considered an ineligible student household.

Under penalty of perjury, I certify the information presented in this affidavit is true and accurate to the best of my knowledge. I understand that providing false representations herein constitutes an act of fraud. False, misleading, or incomplete information may result in the termination of the lease agreement. I will provide proof of credit hours or other documentation that may be required for each school term during my occupancy of a unit at this rental community. I/we agree to notify management immediately of any changes in this household's student status. I understand that enrolling as a full-time student may result in the termination of a lease agreement.

Head of HouseholdDateOther AdultDate

Other AdultDateOther AdultDate

R-23 Certification of Student Status 1 of 1 June 2015