Certificate of Residency Form

Certificate of Residency Info / Requirements

Fill out the form below to receive a certificate of residency. To submit the online form you must upload proof of address. All documents submitted as proof of address must include the following information:

include the student’s name;
physical street address (not a PO Box); and
be dated accordingly

View Examples of Acceptable Proof of Address Documents

Report cards with an issue date of 1-year old, or within 30 days
High school transcript
College correspondence including bills or schedule of classes
NYS TAP Information
Bank statements
Tax bill
Utility bills
Dated mail or postmarked envelopes
Formal lease
Voter Registration Card
Driver’s license
Car registration and/or insurance card may be used when the issue date reflected is 1 year old, or within 30 days of application
Green Card
Filed Applications for Permanent Residency

* Required Fields

Upload Proof of Address

Upload Files

Allowed file types: jpg, gif, png, pdf. Max file size: 5mb.

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School*

First Name*

Middle Name

Last Name*

Email*

Re-Enter Email*

Phone*

Social Security Number or School ID (optional)

Format: 123121234 (numbers only - do not enter spaces or dashes)
Note: If you do not want to provide your SSN, please enter your school id from the previous year, or leave this field blank.

Residence Address

Street Name & Number*

Address Line 2 (apt #, etc.)

City*

State*

Zip Code*

Municipality*

Please select the specific municipality you reside in.

Is your mailing address the same as your residence address? *

Yes

Have you been a legal resident of New York State for AT LEAST ONE YEAR prior to the date of this application? *

Yes

Have you been a resident of Monroe County for AT LEAST SIX MONTHS prior to the date of this application? *

Yes

I declare that the statements made in this application have been examined by me and to the best of my knowledge and belief are true and correct. *

Monroe County, NY Adam J. Bello · County Executive

Certificate of Residency Form

View Examples of Acceptable Proof of Address Documents