Out of District Enrollment Form for 20-21
1. Student's Name (Last, First, Middle) *
Student's Name (Last, First, Middle)
Your answer
2. Student Birthday *
mm/dd/year
Your answer
3. Student's Status *
4. Student will be in which grade for the 2020-2021 year? *
5. In which Nelson County School is your child currently enrolled? *
Please select the school or select "Not currently coming from the Nelson County School District"
6. Does this student have an Individual Education Plan? *
7. Does this student have a 504 Plan? *
8. Does this student receive any special services while at school? *
If yes, please briefly describe below.
Your answer
9. Has this student ever been suspended or had other behavior issues in school? *
If yes, please briefly describe below.
Your answer
10. Has this student had any issues with regular school attendance? *
If yes, please briefly describe below.
Your answer
11. Please briefly describe this students academic performance in school? *
Your answer
12. Please briefly explain the reason(s) for making an out-of-district request below. *
Your answer
13. Student's Primary Address *
The full address where the student is living, including zip code.
Your answer
14. Parent/Guardian Name (Last, First, Middle) *
I declare that I am the parent or legal guardian of student applying
Your answer
15. Parent/Guardian Primary Phone Number *
Your answer
16. Parent/Guardian email address *
Your answer
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