Residency/Allen Bill Form for BOUSD

Residency/Allen Bill Form for BOUSD

1 Civic Center Circle, Level 2, Brea, CA 92821 (714) 990-7800
Per Education Code 48204, parent or guardian who is physically employed within the Brea Olinda Unified School District boundaries for a minimum of 10 hours per week may be able to enroll their student through the Allen Bill enrollment option.

This means that even if the student does not reside within our attendance boundaries, they may be able to attend a Brea Olinda Unified School District school without requesting an interdistrict permit based on the parent's/guardian's place and hours of employment.

Parents or guardians must complete this online Allen Bill Form and provide verification of employment within our district boundaries.

Reapplication and/or re-verification may be required. Transportation is the parent’s responsibility.

Applications may be denied if false information is submitted, if there is not sufficient space available to accommodate the student’s enrollment, or the cost of educating the pupil would exceed the amount of additional state aid received as a result of enrollment.
Student Information
School Year Applying for:
Student Name

First NameLast Name
Student Birthdate

MonthDayYear
Date

Current and Future Grade Level

	2025-26	2026-27
Grade Level

Student Gender
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Cell Number
Please enter a valid phone number.
Residence Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current School
Current District
Is the student enrolled in Special Education (IEP)?

YesNo
Upload Most Recent IEP

Cancelof
Does the student currently have a 504 Plan?

YesNo
Upload Most Recent 504 Plan

Cancelof
Indicate all the Special Programs in which the student in currently enrolled:

Adaptive Physical Education (APE)Resource Specialist Program (RSP)Special Day Class (SDC)Speech and Language ProgramSpecialized Physical CareGifted and Talented Education (GATE)English Language Development (ELD)Free/Reduced Lunch ProgramOther
Has the student ever been expelled?

YesNo
Expulsion explanation:
Employment Information
Employment Verification: A permit may be granted for a student to attend a school in another district if at least one of the parents/guardians of the student is employed within the boundaries of that school district. The parent/guardian must be currently employed on a full-time regular basis, no less than 10 hours per week during school hours, and must provide a copy of most current paystub (please blackout dollar amount) OR a letter from the employer on the company/ organization’s letterhead.
Employment Address

Business Name

Street Address

CityState / Province

Postal / Zip Code
Employment Verification Documents

Cancelof
PARENT AFFIDAVIT

I certify that all information submitted in my application is true and correct. I understand that reapplication and/or re-verification may be required. An approved Allen Bill form may be revoked for any of the following reasons:
- Space unavailability
- Poor attendance
- Poor academic performance
- Poor citizenship/behavior
- Providing false information
- Other reasons that may be determined by the Board of
  Education
I agree, if this transfer is approved, to provide safe transportation to/from school.
Signature

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Date

MonthDayYear
Date
Should be Empty:

Residency/Allen Bill Form for BOUSD

Student Information

Employment Information