JFB-E

EXHIBIT

OPEN  ENROLLMENT

ATTENDANCE APPLICATION
File this application at the School District office

Student's name  ________________________________________________________
                            Last                                         First                                             M.I.

Current grade ______   Birth date ____________   Home phone __________________

Work phone ______________________    Message phone ______________________

Parent's name  _________________________________________________________
                            Last                                        First                                              M.I.

Home address _________________________________________________________
                           Street                                      City                                               Zip

E-mail address _________________________________________________________

The above-named student:   ◻ resides outside the School District; or
                                              ◻ resides within the School District

Present school of attendance

School ____________________________    District ___________________________

City  ______________________________    County ___________________________

School of residence

School ____________________________    District ___________________________

City  ______________________________    County ___________________________

Request assignment to __________________________________________ School 

Is the above-named student:

◻  Yes   ◻  No   Expelled or long-term suspended from any school or school district?

◻  Yes   ◻  No   Currently subject to expulsion or long-term suspension from a school 
                           or school district?

◻  Yes   ◻  No   ◻  N/A   In compliance with conditions imposed by a juvenile court?

◻  Yes   ◻  No   ◻  N/A   In compliance with a condition of disciplinary action in any 
                                         school or school district?

◻  Yes   ◻  No   ◻  N/A   Is the student receiving special education services under
                                        an individualized education program (IEP)?

Note:  The following conditions apply to the open-enrollment program:

1.  An attendance application must be completed and submitted on or before April 1.

2.  Enrollment is subject to the capacity limit established for the school and/or its grade levels.

3.  On or before July 1, the parent or legal guardian will be notified in writing whether the application has been accepted, rejected, or placed on a waiting list.

4.  Transportation for the student may be the responsibility of the parent or legal guardian.

5.  Providing false information on this form may result in the application being denied or admission being revoked.

The signatory affirms that the student will abide by the rules, standards, and policies of the school and the District if enrolled.

_________________________________________      _________________________
          Signature of Parent or Legal Guardian                                      Date

            FOR DISTRICT USE ONLY  ***  DO NOT WRITE BELOW THIS LINE
_____________________________________________________________________

 

Student number _______________________    Date stamp _____________________
                                                                                                            Filing Date

◻  Accepted  ◻  Placed on waiting list      Principal ____________________________
                                                                                                         Date

◻  N/A - ◻ Date Special Services Director consulted  __________________________

◻  Rejected - Reason for rejection _________________________________________

Form on file with school.