Clinton City Schools Request for Out-of-District Acceptance 2022-2023
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Email *
Email *
Request *
STUDENT'S FIRST NAME
STUDENT'S MIDDLE NAME
STUDENT'S LAST NAME *
STUDENT'S SCHOOL ID NUMBER
ETHNICITY *
WHAT SCHOOL WERE YOU ENROLLED IN 2021-2022 *
2021-2022 GRADE *
PARENT/GUARDIAN(S) FIRST NAME *
PARENT/GUARDIAN(S) LAST NAME *
MAILING ADDRESS *
CITY, STATE, ZIP CODE *
PARENT/GUARDIAN(S) CELL PHONE NUMBER *
PARENT/GUARDIAN(S) WORK PHONE NUMBER
RESIDENCE ADDRESS (IF DIFFERENT FROM MAILING ADDRESS)
GRADE (2022-2023 SCHOOL YEAR) *
SCHOOL DESIRED (2022-2023 SCHOOL YEAR)
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IN WHAT SCHOOL DISTRICT DO YOU RESIDE? *
IF YOU CHECKED OTHER IN THE ABOVE QUESTION, PLEASE STATE DISTRICT YOU RESIDE IN
WHAT IS YOUR REASON FOR THIS REQEST? *
IS STUDENT IN GOOD STANDING (ACADEMICALLY, ATTENDANCE AND/OR DISCIPLINE) *
IF NO TO THE 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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