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.