Out-of-District Student Request K-12

Parent's Name*
Email*
example@example.com
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*
Alternate Phone
How many K-6 grade students will you be registering?*
How many 7-12 grade students will you be registering?*
Student Information:
Child #1
Student Name*

First NameLast Name
Current Age*
Anticipated grade for the school year*
Child #2
Student Name

First NameLast Name
Current Age
Anticipated grade for the school year
Child #3
Student Name

First NameLast Name
Current Age
Anticipated grade for the school year
Child #4
Student Name

First NameLast Name
Current Age
Anticipated grade for the school year
Previous School Address*

Name of School

School Mailing Address

CityState / Province

Postal / Zip Code
Has your student(s) received multiple infractions for behavior in the past year?*

YesNo
Have you been to truancy for your student(s) in the past year?*

YesNo
Has your student(s) been expelled from their present or previous school?*

YesNo

Student Information: