Interdistrict Open Enrollment Application
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District of Residence
Student First Name *
Student Middle Name(s) *
Student Last Name *
Student Address *
Student Date of Birth *
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/
DD
/
YYYY
Parent/Guardian #1 Name *
Parent/Guardian #1 Address *
Parent/Guardian #1 Telephone *
Parent/Guardian #1 Email *
This email address will receive follow-up information, updates and other details.
Parent/Guardian #2 Name:
Parent/Guardian #2 Address:
Parent/Guardian #2 Telephone:
Parent/Guardian #2 Email:
Western Brown School to Attend *
Grade Level of Student in 2024-2025 *
Does Student Have IEP *
If yes, Explain
If student will be in grades 9-12, list all courses requested for 2024-2025 School Year.  
Parent Signature *
Type first name, last name. By providing an electronic signature, parent/guardian give permission for their student to attend, should they be accepted.
Applications must be received in the Superintendent's office not later than May 26, 2024.  Applications will be acted upon not later than July 1, 2024.
If applying after deadline, please state reason(s).
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