Contact Information

Shauna Ashmore
Director, Student Support Services
(805) 497-9511 x3321
Email

Maria Chavez
Student Support Services
GATE, SARB, Caregiver Authorization, Homeless/Foster Care
(805) 497-9511 x3320
Email

Caregiver's Authorization

Caregiver's Authorization Affidavit
To transfer responsibilities to a “qualified caregiver” you will need to fill out the Caregiver’s Authorization Affidavit. It is a multi-page form that requires notarized signatures from the parents, and notarized signature from the custodial adult.  Additionally we need a copy of the caregiver's license, proof of caregivers address (utility bill) and transcripts from previous school.

Click here for a sample of the Caregiver’s Authorization Affidavit.

Click here for a sample of the Caregiver's Authorization Affidavit in Spanish

Caregiver’s Authorization Forms are available in Student Support Services, District Office and must be approved by the Director of Student Support Services.

Qualified Relative

A qualified relative means a spouse, parent, stepparent, brother, sister, stepbrother, stepsister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin or any person denoted by the prefix “grand” or “great” or the spouse of any of the persons specified in this definition, even after the marriage has been terminated by death or dissolution.

If the minor stops living with you, you are required to notify any school, health care provider, or health care service plan to which you have given this affidavit.