Clinton City Schools Request for Out of District Acceptance
Email address *
REQUEST *
STUDENT'S FIRST NAME *
STUDENT'S MIDDLE NAME *
STUDENT'S LAST NAME *
STUDENT'S ID
ETHNICITY *
2019-2020 SCHOOL ENROLLMENT
2019-2020 GRADE
PARENT/GUARDIAN(S) FIRST NAME
PARENT/GUARDIAN(S) LAST NAME
MAILING ADDRESS ( Address, City, State, Zipcode) *
PARENT'S CELL PHONE NUMBER *
PARENT'S OTHER CONTACT NUMBER
PARENT'S WORK PHONE NUMBER
RESIDENCE ADDRESS (IF DIFFERENT FROM ABOVE)
GRADE (2020-2021 SCHOOL YEAR) *
SCHOOL DESIRED (2020-2021 SCHOOL YEAR) *
IN WHAT SCHOOL DISTRICT DO YOU RESIDE? *
WHAT IS YOUR REASON FOR THIS REQUEST? *
IS STUDENT IN GOOD STANDING (ACADEMICALLY, ATTENDANCE AND/OR DISCIPLINE)? *
IF NO TO ABOVE QUESTION, PLEASE EXPLAIN.
HAS THE STUDENT EVER BEEN SUSPENDED OR EXPELLED? *
IF YES TO THE ABOVE QUESTION, PLEASE EXPLAIN.
DOES THE STUDENT HAVE A CURRENT IEP FOR SPECIAL EDUCATION SERVICES? *
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