Student�s Full Name: _____ Phone

Document Sample
Student�s Full Name: _____ Phone Powered By Docstoc
					               RIPLEY UNION LEWIS HUNTINGTON LOCAL SCHOOL DISTRICT
                 INTERDISTRICT OPEN ENROLLMENT APPLICATION
                                                       2012-2013 School Year

Student’s Full Name: _________________________________ Phone: ____________
Student’s Birthdate: _____________ Student’s SSN: ___________________
Parent(s)/Guardian(s) Name & Address:______________________________________
______________________________________________________________________
If parents are divorced, who has legal custody of student? _______________________
If shared custody is in place, who has residential custody of student? _____________
          (Please be prepared to leave a copy of all divorce decrees and custody orders with our office.)

Does the student have any family members residing in the same household who are
also submitting an Open Enrollment Application? If yes, please state the name(s):
____________________________________________________________________
Student’s Current District of Residence: _____________________________
Grade Level of student for upcoming school year: ________________
Does the student have an IEP for a Special Education Program? _____________
If “yes”, for what program? _______________ In what district? ________________
__________________________________________________________________
Total days suspended or expelled last semester: _____ Last school year: _____
Total days absent last school year: ___________
High School Students must list desired classes:

________________                __________________ ____________________ ______________________


________________                __________________ ____________________ ______________________

Note: Students who owe Ripley Union Lewis Huntington Schools fees of any kind, or owe money for fundraisers of any
other amounts, MUST pay these amounts before an application for open-enrollment will be accepted for the 2012-2013
school year. For Grades K-6, all 2012-2013 school fees must be paid in advance before your application will be approved.
(High School fees vary per classes and must be paid when you pick up your schedule.) Any of the above questions
answered untruthfully may deem this application null and void and no further action will be taken to consider the student
for open-enrollment into Ripley Union Lewis Huntington Schools.


I have read the above and sign this to be my full statement as the Parent/Legal
Guardian of_________________________________________________________
                                         (Student Name)

_______________________________________________________                                                                ________
Parent(s).Guardian(s) Signature                                                                                        Date

    Please return to: Pat Kimble, Superintendent, Ripley Union Lewis Huntington Local Schools,
                                                 P O Box 85, Ripley, OH 45167
                             MUST BE POSTMARKED NO LATER THAN JUNE 15, 2012
                                (Requests will be acted upon no later than July 30, 2012.)
----------------------------------------------------------------------------------------------------------------------------- ---------------
Received by: ___________________________________                                                  Date: ________________

Application Approved ________________            Rejected __________________
Reason(s):_____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Signature of Official: ________________________________                                           Date: _________________

                                                                                                                          Revised 3/2012

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:9/17/2012
language:Unknown
pages:1