Grade Entering: *
Student's Name: *
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Parent/Guardian Name: *
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Student's Address of Primary Residence: *
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City: *
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Zip: *
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Home Phone #:
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Cell Phone #: *
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Student's Present School:
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Board of Education Policy & Regulation
Please check the following boxes: *
Next Steps
𝐏𝐥𝐞𝐚𝐬𝐞 𝐝𝐫𝐨𝐩 𝐨𝐟𝐟 𝐭𝐡𝐞 𝐟𝐨𝐥𝐥𝐨𝐰𝐢𝐧𝐠 𝐢𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧 𝐭𝐨 𝐌𝐫𝐬. 𝐓𝐞𝐫𝐞𝐬𝐚 𝐎𝐬𝐛𝐨𝐫𝐧𝐞 (𝐖𝐢𝐥𝐥𝐢𝐚𝐦 𝐇 𝐑𝐨𝐬𝐬 𝐒𝐜𝐡𝐨𝐨𝐥, 𝟖𝟏𝟎𝟑 𝐖𝐢𝐧𝐜𝐡𝐞𝐬𝐭𝐞𝐫 𝐀𝐯𝐞𝐧𝐮𝐞) 𝐚𝐟𝐭𝐞𝐫 𝐜𝐨𝐦𝐩𝐥𝐞𝐭𝐢𝐨𝐧 𝐚𝐧𝐝 𝐬𝐮𝐛𝐦𝐢𝐬𝐬𝐢𝐨𝐧 𝐨𝐟 𝐭𝐡𝐢𝐬 𝐟𝐨𝐫𝐦:

• Most recent report card

• IEP and/or 504 Plans (if applicable)

• Most recent standardized test results (if available)

If this is a kindergarten registration, all health records are necessary and any preschool reports or evaluations will be helpful.

Parent’s/Guardian’s Signature (upon drop-off of information listed above)*:



* An application will not be considered complete until all paperwork is received along with parent signature.

Office Use

Application submission date: _______________

Received by: _____________________

Administration/CST Interview and tour date: _________________

Testing date: __________________

Student’s records received date: _________________

Recommendation for acceptance:

Yes [ ]

No [ ]

Comments (Optional) ______________________________________________________________


Principal Signature:_________________________________________________________________


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