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AP 1003 OpenEnrollmentApplicationSecondaryIdaho Falls School District 91 October 2012 IDAHO FALLS SCHOOL DISTRICT 91 SECONDARY OPEN ENROLLMENT APPLICATION Misrepresentation of information on this application may result in denial of an application or revocation of the applicant’s approval to attend an Idaho Falls School District 91 school. NOTE: Out-of-district applicants must attach a signed Student History Form to this application. The information required must be obtained from the student’s current school, signed by the student’s current principal/designee and completed form turned into the school wanting to attend. Date of Application: 1. Applicant Student’s Name: 2. Date of Birth: 3. School student is presently attending or would attend if student were in a public school. Name of School and District: Address of School: City/Zip Code: Present Grade Level of Student: 4. Name of Desired Receiving School: 5. Has the student ever been suspended or expelled from school or has the student committed a disciplinary violation for which he/she could be suspended or expelled? □Yes □No If YES, describe the circumstances (including dates and duration). 6. Has the student had any disciplinary/attendance infractions during the past school year? □Yes □No If YES, describe the circumstances (including dates and duration). Idaho Falls School District 91 October 2012 7. Reason(s) for requesting attendance in this school. 8. Special and/or unique instructional programs in which the applicant student is currently enrolled. (e.g. vocational, foreign language, remedial, special education, gifted/talented, etc.). 9. Special and/or unique instructional programs in which the applicant student expects to enroll in the new school. NOTE: Some specialized programs are only offered in a limited number of schools (e.g. special education, English Language Learner, etc.) Please contact Idaho Falls School District 91, 525-7512, for more information. 10. Extra-curricular activities in which the applicant wishes to participate. NOTE: A student who anticipates participating in a sport governed by the Idaho High School Activities Association (IHSAA) should review eligibility rules prior to submitting an open enrollment application. IHSAA regulations may require one year of ineligibility at the varsity level for certain school transfers. 11. Transportation arrangements will be made by the parent/guardian as follows: Parent/Guardian Name: Parent/Guardian Address: City/Zip Code: Home Phone: Father’s Mother’s Home Phone: Home Phone: Cell Phone: Cell Phone: Idaho Falls School District 91 October 2012 SIGNATURE PAGE Parent Acknowledgement: I have read the Idaho Falls School District 91 policy and procedure on open enrollment and hereby request that my son/daughter be permitted to attend (Name of Proposed Receiving School) Parent/Guardian Signature In-District Transfer: Anticipated enrollment date: Zoned School Principal’s Acknowledgement of Open Enrollment Application Zoned School Zoned School Principal Signature Date Receiving School Principal’s Recommendation: □Approve □Disapprove Receiving School Receiving School Principal Signature Date Out-of-District Transfer: Anticipated enrollment date: Receiving School Principal’s Recommendation: □Approve □Disapprove Receiving School Receiving School Principal Signature Date For School Use Only For School Use Only Idaho Falls School District 91 October 2012 OPEN ENROLLMENT STUDENT HISTORY FORM Directions: 1. This form must be completely filled out by the student’s current principal/designee and attached to the Idaho Falls School District 91 Open Enrollment Application. 2. The current school principal’s signature is required. Student Name: Grade: ABSENCE Number of days the student was absent during the past two grading periods: DISCIPLINE Has the student had any disciplinary infractions during the past two grading periods? If yes, indicate the number of infractions: □Yes □No Explanation of infractions: Has the student been suspended during the past two grading periods? □Yes □No If yes, please explain: Does the student have an expulsion hearing pending? □Yes □No If yes, please explain: Has the student ever been expelled from school attendance? □Yes □No If yes, please explain: SPECIAL PROGRAM ENROLLMENT □Title 1 □Special Education □LEP □Migrant □Gifted and Talented □Other ACADEMIC STANDING (please attach a copy of the following): □The most current report card for Elementary students OR □The most current complete transcript for Secondary students Current School Current School Principal Signature Date