HomeMy WebLinkAboutAP 1003 OpenEnrollmentApplicationElementaryIdaho Falls School District 91
ELEMENTARY OPEN ENROLLMENT APPLICATION
School Year 20____ - 20____
Grade
NOTE TO OUT-OF-DISTRICT APPLICANTS: A copy of the applicant student’s cumulative record must
be attached to this application. The cumulative record may be obtained from the student’s current school.
( ) Out-Of-District Application Name of District
( ) In-District Transfer Application
Name of Proposed Receiving School:
Some specialized programs are only offered in a limited number of schools. (i.e. special education, English
Language Learner, etc.) Please contact Idaho Falls School District 91, 208-525-7500, for further information.
1 - Applicant Student’s Name:
Date of Birth:
2 - School student is zoned to attend:
Name of School:
Address of School:
Present Grade Level of Student:
3 - Reasons(s) for requesting attendance in this school.
4 - Special and/or unique instructional programs in which the applicant student is currently
enrolled. (i.e. special education, gifted/talented, etc.)
5 - Special and/or unique instructional programs in which the applicant student expects to
enroll in this school.
6 - Has the student ever been suspended or expelled from school? Yes _____ No _____
IF YES, describe the circumstances (including dates and duration).
7 - Has the student had a history of disciplinary infractions within the past 3 years?
Yes _____ No _____
If YES, describe the circumstances (including dates and duration).
8 - Transportation arrangements that will be made by the parent/guardian:
9 - Parent/Guardian Name:
Parent/Guardian Address:
Zip Code:
Home Phone: Cell Phone:
Message Phone: Work Phone:
I have read the school district policy on open enrollment and hereby request that my son/daughter
be permitted to attend .
Parent/Guardian Signature
Misrepresentation of information on this application may result in revocation of the applicant’s
approval to attend an Idaho Falls District 91 school.
( ) Approved ( ) Disapproved Date:
( ) Discipline ( ) Capacity Overload ( ) Other _________________
Superintendent or Designee Signature:
Within 60 days following action on the application, copies must be sent to: parents, building
principal, and for out-of-district applicants, the superintendent of the home district. If the
application is denied, a written explanation for the denial must be attached.
PRINCIPAL SIGNATURES
In-District Transfer (Zoned School):
In-District Transfer (Receiving School):
Out-of-District Transfer:
Idaho Falls School District 91 does not discriminate or deny services on the basis of age, race, religion, color,
national origin, gender, and/or disability.
Revised: November 2013
(Name of proposed receiving school)