Student School Choice Form

STUDENT SCHOOL CHOICE FORM

This form requests assignment consideration for attendance at a school other than the student's resident school. Completion of this form constitutes a formal application for school choice. Approval is subject to seat availability, program capacity, and district enrollment policies. False statements or failure to provide required documentation may result in denial or withdrawal of placement.

Student Information

Date of Birth:    Student ID (if known):    Grade/Program for requested placement:

Primary Phone:    Student Email:

Parent / Guardian Information

Relationship to Student:    Primary Phone:    Email:

Choice Request

Requested Start Date:    Requested Program or Track:

Special Programs and Services

IEP / Special Education    504 Plan    English Learner / Bilingual Services    Title I Services

Transportation and Attendance

I request district transportation to the requested school: (Check if needed)

I understand that transportation to a choice school is not guaranteed and may require different pickup/drop-off arrangements; if not provided, transportation is the responsibility of the parent/guardian.

Records Release and Consent

By signing below, I authorize the release and exchange of academic records, health and immunization records, discipline records, special education records (including IEP or 504 documentation), and attendance records between the student's current school, the requested school(s), and district administrators for the purpose of processing this application.

Current School Name:    I consent to release:

Residency and Eligibility

Applicants must be residents of the district unless submitting an inter-district transfer request. Proof of residency must be provided upon request. Falsification of residency or other required information is grounds for denial or withdrawal of placement and may require repayment of tuition or other remedies permitted by policy.

I acknowledge that I will provide required documentation upon request:

Prior Discipline

Has the student ever been suspended, expelled, or subject to a discipline hearing?

Acknowledgment and Certification

I certify under penalty of perjury that the information provided on this form is true and correct to the best of my knowledge. I understand that approval of this application is contingent upon seat availability, program eligibility, and compliance with district policies. I further acknowledge that acceptance of a choice placement may affect extracurricular eligibility, course offerings, and graduation requirements, and that transportation may not be provided.

I authorize district personnel to verify the statements herein and to obtain records necessary to process this application. I understand that if this application is approved, additional enrollment forms and verifications will be required before final enrollment is complete.

Office Use Only

Decision: Approved    Denied    Pending

Assigned School (if approved):    Effective Start Date:

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