Patrick Henry Local Schools-Open Enrollment Form 2019-2020
This document serves as the application for interdistrict open enrollment for the 2019-2020 school year. Each student should be submitted on a separate form.

Applications for open enrollment are approved for only ONE year. Returning students should submit their applications by June 14th and new student applications are due by July 31st.

Name of Student *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
District of Residency *
Your answer
Current School Attending *
Your answer
Grade Level of Student for Upcoming School Year *
Your answer
Name of Parent/Legal Guardian *
Your answer
Mailing Address *
Your answer
City, State, Zip Code *
Your answer
Home Phone *
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
Does the student have an Individualized Education Plan (IEP)? *
Has the student been suspended /expelled for 10 days or more during the current or preceding semester? *
Parent/Guardian Signature-Electronic Signature
Your answer
Submit
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