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AP 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)