Read By Grade 3
Child's Name:
First Name
Last Name
Adult Completing Form's Name:
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Student's Home Building:
Please Select
Disney
Edison
Emerson
Eisenhower
Salk
Twain
I would like to file a Good Cause Exemption for my child for the following reason(s):
My child has an IEP
My child has a 504
My child has limited English
My child was already retained
My child has been enrolled in Fraser for less than 2 years
Other
Questions or Concerns:
Signature
Once your form is submitted, administration will review and confirm a decision regarding next year’s placement.
Submit
Should be Empty: