Littleton Public Schools Exhibit
Policy Code Policy Name
JFBB-E-1
Interdistrict Enrollment (Nonresident Students) June 18, 2009
20122013 APPLICATION FOR ADMISSION OF NONRESIDENT STUDENT
Please Print and Complete Entire Form
Student Name (Last, First) Address Parent/Guardian Name Date of Birth City Work Telephone(s) Mother: Father: Phone Number
School District Student Would Normally Attend
Name of School Phone
New Applicant Continuing Student
Home Telephone Zip Code
School Currently Attending
School Requested Do you have a sibling attending the school you are requesting? Student of Littleton Public Schools Employee? Yes If yes, Parents Name Reason for Admission Request Indicate Code (see bottom of page) No Location
Grade Level Fall of 2012 Name of Sibling
Does the student have a current Individual Education Program (IEP)? Is the student currently being tested for special education placement? Is the student receiving or identified as eligible to receive special education services? Does the student have a current 504 plan?
Yes Yes Yes Yes
No No No No
If the student has a current IEP at the most recent school attended, the signature of the parent/guardian acknowledges that the District of Jurisdiction (place of residence) has made available a free appropriate public education for the student. Applications for students receiving special education services will require approval by Special Education staff. Denied Approved Signature of Director of Special Education
If this application is approved, I understand and agree to abide by the following: 1. The district is not responsible for providing transportation. 2. Athletic eligibility is determined by the Colorado High Schools Activities Association (CHSAA) and the laws of the state of Colorado. Contact the Athletic Director of the appropriate school. Additional information is available at www.chsaa.org. The signature of the student or parent/guardian below signifies that all parties understand and agree to abide by the procedures related to acceptance of nonresident students. Signature of Parents/Guardians or Student (if 18 or older) Please forward application to the school you wish to attend.
(THIS INFORMATION IS NEEDED TO PREPARE ANNUAL REPORTS TO THE BOARD OF EDUCATION)
Date
Codes for reasons for admission request
A B C D E F G H I J Child Care Convenience Dissatisfaction with previous district Family reasons Fresh start Friendship Health reasons Moved out of attendance area International Baccalaureate Reputation of LPS O Q R 1 2 3 Dropped out of LPS in prior year Admit from home-study program Admit from private school Academic Programs Athletic Program Nonacademicmusic, drama, technology, etc. 4 Extracurricular programs
School Use Only
Accepted (date) Wait List Grid Code Verified as A00 Denied (date) program/grade level/school at capacity expulsion status behavior detrimental to others Parent Notified
Signature of Principal
Date
cc: Special Education Level Coordinator
Escuelas Pblicas de Littleton
Cdigo de Poltica JFBB-E-1 Nombre de Poltica Matrcula Interdistrital
Estudiantes No Residentes Junio 18, 2009
2012-2013 APLICACIN DE MATRICULACIN ABIERTA O TRASPASO PARA ALUMNOS AFUERA DEL DISTRITO ESCOLAR
Por favor de usar letras de bloque y completar el formulario completo:
Nombre de alumno/a (Apellido, Nombre) Direccin Nombre de Padres Fecha de Nacimiento Cuidad Telfono Codo Postal Telfono del trabajo Madre: Padre: Escuela de su vecindad Nivel Escolar en 2012 Nombre del familiar
Escuela donde asista ahora Escuela donde quiere asistir
Telfono de la escuela
Hay un familiar asistiendo la escuela en donde quiere asistir? Fecha del primer asistencia en el distrito escolar El razn para su pedido: Indique el razn con el codo debajo: Tiene el alumno/a un plan corriente de Programa de Educacin Individual (IEP)? Este alumno/a esta en medio de tener evaluaciones de Educacin Especial? Esta recibiendo o identificado elegido recibir servicios de Educacin Especial? Tiene el alumno/a un plan corriente de 504?
Si Si Si Si
No No No No
Si el alumno/a esta recibiendo o ha sido identificado elegido recibir servicios de Educacin Especial con un plan de Programa de Educacin individual (IEP), la aplicacin tiene que tener el apoyo del los maestros de Educacin Especial. Repulsada Apoyado Firma del Director de Educacin Especial Si apoyen esta aplicacin, yo entiendo y estoy en acuerdo seguir lo siguiente: 1. El condado escolar no tiene responsabilidad a proveer transportacin escolar. 2. Elegibilidad atltica es determinada por la Asociacin de Actividades de las Escuelas Segundarias de Colorado (CHSAA) y las leyes del estado de Colorado. Hay mas informacin disponible a www.chsaa.org. La firma del estudiante, padre o representante abajo, significa que todas las partes entienden y acuerdan regirse por los procedimientos relativos a la aceptacin de estudiantes de otras escuelas. Firma de los padres o alumno (Si tenga 18 o ms aos) Fecha
Por favor de entregar esta aplicacin a la escuela donde quiere asistir
(ESTA INFORMACIN ES NECESARIO PARA PEPARAR REPORTES ANUALES A LA JUNTA DIRECTIVA DE LAS ESCUELAS)
Los codos de los razones para el pedido de matriculacin abierta
A Cuidado de los nios B Comodidad C Dissatisfecho con la escuela/distrito previo D Razones familiares E Una empieza nueva F Las amistades G Razones de salud H Mudado de residencia I Baccalaureate International J Reputacin de las escuelas Q R 1 2 3 Entrada de los estudios de casa Entrada de una escuela privado Programas acadmicas Programas atlticas No-acadmicamsica, drama, tecnologa, etc. 4 Programas extras
School Use Only
Accepted (date) Wait List Home School Notified Grid Code Verified Denied (date)
program/grade level/school at capacity expulsion status behavior detrimental to others
Parent Notified
Signature of Principal Date
cc:
Special Education Level Coordinator
Board Exhibit JFBB-E-1Interdistrict Enrollment (Nonresident Students) Application for Admission of Nonresident Student
