New Lebanon Local School District
INTER-DISTRICT OPEN ENROLLMENT ENROLLMENT STUDENT APPLICATION

Please answer each question completely and double-check to make sure there are no typographical errors.  This form will serve as your child's initial application for open enrollment and we will require more paperwork (signed application and individualized education plans) at a later time.

At this time, grades 2 and 7 are closed due to large existing enrollments at those grade levels.

 Please submit a separate application if requesting open enrollment for more than one child.
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Email *
Name of Student *
Social Security Number
Optional on electronic form; required before acceptance
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian last name *
Parent/Guardian first name *
Current Address (street, city, zip code) *
Phone number *
School district of residence *
Last school district attended *
Current Grade *
Grade Requested-Grades available 1st, 3rd, 4th, 6th, 9th, 10th, 11th, and 12th.  Kindergarten students will be placed on a waiting list. Acceptance is based on class size and program offerings. *
Do you have a child currently enrolled as an open enrollment student? If yes answer next question. *
Name of child(ren) currently enrolled as an open enrollment student(s).
List each student separated by commas.
Has this student been expelled or suspended from school? *
Number of absences for the present school year. (Excused and Unexcused) *
Is student enrolled in any special education or tutorial program? *
If yes, please explain. (IEP must be attached to application) *
Why do you want your child to attend Dixie Schools *
High School Students Only-Number of high school credits anticipated at the end of the present school year. *
By checking yes, I certify that all information in this application is true and complete.  I also acknowledge that an incomplete/inaccurate application may result in a denial of open enrollment. *
By checking yes, I acknowledge receipt of the Parent/Student Open Enrollment Guidelines (available on the website) for the New Lebanon Local Schools and we acknowledge the expectations, procedures, and consequences explained throughout. *
Link for open enrollment policy  https://drive.google.com/file/d/1JSh4B7C0e-U1NADeUlyHiW6bhMiKyJu3/view?usp=sharing  Copy and past into browser if you are unable to click the link.
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