NONRESIDENT STUDENT ENROLLMENT APPLICATION

NONRESIDENT STUDENT ENROLLMENT APPLICATION

SOUTH HAVEN USD #509
All nonresident students (students whose parents/legal guardians live outside USD 509 school boundaries) are required to submit a nonresident student enrollment application annually. Nonresident students will be considered for admittance only at the beginning of a semester grading period.
Date of Application*

MonthDayYear
Date
Student's Name*

First NameLast Name
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Current Grade Level*
Parent's/Legal Guardian Name*

First NameLast Name
Parent's Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Relationship to student: Please check correct answer.*

MotherFatherSiblingStep MotherStep FatherUncleAuntMaternal GrandparentsPaternal GrandparentsOther, Please Comment-- _____________________________________________________________
What is your district of legal residence?*
What school did you attend last year?*
Have you been suspended or expelled from another school?*

yesNo
If yes, please explain.
Have you been expelled from South Haven Schools?*

YesNo
If yes, please explain.
Did you withdraw from another school due to either poor attendance, disciplinary reasons, or poor academic performance?*

yesNo
If yes, please explain.
Why do you want to attend a South Haven District school? Please be specific.*
NOTE: Students who have been suspended, expelled, or who have withdrawn from another school due to poor grades, poor attendance, or disciplimary reasons may not be admitted in USD #509.
Student's Signature and Date

Clear
Parent's Signature and Date*

Clear
NOTE: Violation of school rules and regulations may result in the immediate termination of this enrollment application. Nonresident students (out of district) who become a disciplinary problem, establish poor attendance, or suffer from poor academic performance while attending a South Haven district school will not be allowed to continue their education in USD #509. Class size may be a determining factor for approval.
For School Office use only.
Disposition:

GrantedDenied
Principal's Signature

Clear
Date

MonthDayYear
Date
Superintendent's Signature

Clear
Date

MonthDayYear
Date
Should be Empty: