APPLICATION FOR TRANSFER TO A NON-RESIDENT DISTRICT

“ARKANSAS PUBLIC SCHOOL CHOICE ACT OF 1989”

APPLICANT INFORMATION

Applicant Name

Date of Birth           /        /               Gender     Male     ▢     Female     ▢                  Grade (next school year)

Does the applicant require special needs or programs?          Yes     ▢     No     ▢

Is applicant currently under expulsion?          Yes     ▢     No     ▢

ETHNIC ORIGIN (CHECK ONE)

2 or More Races      ▢  

African American     ▢                    Asian                          ▢                          Hispanic     ▢

Native American /    ▢                   Native Hawaiian /      ▢                           White         ▢

Native Alaskan                                 Pacific Islander

RESIDENT SCHOOL DISTRICT OF APPLICANT

District Name                                                                                 County Name

Address

Phone

NON-RESIDENT SCHOOL DISTRICT OF APPLICANT WISHES TO ATTEND

District Name     BRYANT SCHOOL DISTRICT                    County Name     SALINE

Address              200 NW 4th STREET, BRYANT, AR 72022

Phone                 (501) 847 - 5600

PARENT OR GUARDIAN INFORMATION OF APPLICANT

Name                                                                                           Home Phone

Address                                                                                       Work Phone

Parent / Guardian Signature                                                                         Date

Pursuant to standards adopted by a non-resident school board a non-resident district may reserve the right to accept and reject applicants based on capacity of programs, class, grade level, or school building.  Likewise, a non-resident district’s standards may provide for the rejection of an applicant based upon the submission of false or misleading information to the above listed request for information when that information directly impacts the legal qualifications of an applicant to transfer pursuant to the School Choice Act.  However, a non-resident district’s standards shall not include an applicant’s previous academic achievement, athletic or other extra curricular ability, handicapping conditions, English proficiency level, or previous disciplinary proceedings, except that an expulsion from another district may be included pursuant to Ark. Code Ann §6-18-510.  Priority will be given to the applicants with siblings attending the district.  The non-resident district shall accept credits toward graduation that were awarded by another district and award a diploma to a non-resident applicant if the applicant meets the non-resident district’s graduation requirements.  This application must be filed in the non-resident district or postmarked no later then July 1 of the year in which the applicant would begin the fall semester at the non-resident district.

DISTRICT USE ONLY

Application          Accepted     ▢                    Rejected     ▢

Date Notification Sent to Parent / Guardian of Applicant

Date Notification Sent to Resident District