Pike-Delta-York - INTERDISTRICT OPEN ENROLLMENT APPLICATION

PIKE-DELTA-YORK LOCAL SCHOOLS INTERDISTRICT OPEN ENROLLMENT APPLICATION
This application must be returned to the Superintendent's Office between March 1st and April 30th. Open enrollment is on a yearly basis; an application must be submitted for each student for each year.
Contact Email (This is where the approval or denial notice will be sent.)
example@example.com
Student Name*
Grade Entering in 2025-2026*
Student Address*
City*
Zip*
Student Date of Birth*

MonthDayYear
Date
Place of Birth*
School District of Residence*
County of Residence*
Does the student have a current IEP?*

YesNo
Please provide a copy of current IEP.*

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Does the student have a current 504 Plan?*

YesNo
Please provide a copy of current 504 Plan. *

Cancelof
Has your child ever been expelled or suspended for the previous or current school year?*

YesNo
Reason(s) you wish to transfer:*

Course Offerings/Educational ProgramsGeographic LocationAthletics/Extra Curricular ProgramsOther
Please explain:
Fathers Name*
Father's Phone*
Mothers Name*
Mother's Phone*
My signature below indicates awareness that completion of this application does NOT provide any permission to change district attendance, it is merely a request to do so. | understand my request to Open Enroll to the Pike-Delta-York Local School District is NOT guaranteed and may be denied. I further understand that notice of approval or denial will be received no later than June 30th.

My signature indicates that administrators of resident district and the district where attendance is desired may exchange all information and records relative to my child. Please provide Proof of Residency with this application.
Please Provide Proof of Residency with this Application. This will not be processed without it.*

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*If you have guardianship, sole custody or shared parenting of this student and there are applicable custody court papers, they must accompany this application. Failure to provide this paperwork will result in delay and possible denial of application.
Additional Required Files

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Parent I Guardians Signature*

Clear
Received by
Date Received

MonthDayYear
Date
Superintendents Signature

Clear
Date

MonthDayYear
Date
Application Approval/Denial

ApprovedDenied
Reason for denial
Should be Empty:

PIKE-DELTA-YORK LOCAL SCHOOLS INTERDISTRICT OPEN ENROLLMENT APPLICATION