BUSD Private School Verification of Enrollment

PRIVATE SCHOOL ENROLLMENT
Private School*
Private School Administrator*

First NameLast Name
Administrator Email*
example@example.com
Private School Address*

Street Address

Street Address Line 2

CityState

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Projected TK12 student enrollment for the year participating in equitable services (update on Census Day) *
Please Upload Student Enrollment for Verification

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Cancelof
Signature*

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Date of Signature*

MonthDayYear
Date
Should be Empty:

PRIVATE SCHOOL ENROLLMENT