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Defiance City Schools 2021-2022 Interdistrict Open Enrollment Application
A separate application is required for each student
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* Indicates required question
Student's First Name
*
Your answer
Student's Middle Name
*
Your answer
Student's Last Name
*
Your answer
Student's Address
*
Your answer
District of Residence
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Sex
*
Male
Female
Grade Level for 2021-2022 School Year
*
Choose
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Ethnicity (Check all that apply)
*
Hispanic/Latino
White
Asian
Black/African American
Native Hawaiian/Pacific Isalnder
American Indian/Alaskan Native
Required
Native Language if other than English
Your answer
Social Security Number
Your answer
Custody (Who the student lives with)
*
Both Parents
Sole Custody
Shared Parenting
Guardianship
Custody/Court Papers Required:
*
Not applicable
Will be provided
On file with building
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Parent Address
*
Your answer
Parent Phone Number
*
Your answer
Parent Email
*
Your answer
Parent 2 First Name
Your answer
Parent 2 Last Name
Your answer
Parent 2 Address
Your answer
Parent 2 Phone Number
Your answer
Does your Child have an IEP/receive special education services?
*
Yes
No
If your child is on an IEP what is their disability?
Your answer
Has your child been suspended/expelled from ANY school district for ten consecutive days or more?
*
Yes
No
Please list any siblings that are also applying for open enrollment:
Your answer
Why have you chosen Defiance City Schools to educate your child?
*
Your answer
Parent/Guardian Signature
*
Your answer
Date
*
MM
/
DD
/
YYYY
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