APPLE VALLEY UNIFIED SCHOOL DISTRICT INTRADISTRICT OPEN ENROLLMENT APPLICATION Request submitted for

2017-18

school year

Date

(Please Print)

STUDENT NAME_____________________________ DATE OF BIRTH____________ 2017-18 GRADE_____ Please answer yes or no to the following questions: Is the student currently pending disciplinary action or under an expulsion from any district? [ ] yes [ ] no Is the student receiving special education services? [ ] yes [ ] no NOTE: All AVUSD Special Education students shall be placed through the IEP process. In order to ensure that the priorities for enrollment in district schools are implemented in accordance with law, applications for Intradistrict Open Enrollment shall be submitted between JANUARY 17 and FEBRUARY 28, 2017 for the 2017-2018 school year. After the enrollment priorities have been applied in accordance with Board Policy 5116.1 (lottery process). BP 5116.1-No student currently residing within a school’s attendance area shall be displaced by another student transferring from outside the attendance area. BP 5118-Once admitted, a transfer student who wishes to matriculate into a district 7 – 8 program, high school or transfer to another district school shall reapply for admission to the new school pursuant to the requirements of Board policy and administrative regulation.

Parent/Guardian Name (print) Parent/Guardian Address City

State

Zip Code

Telephone

REASON(S) FOR REQUEST

☐

Assigned as overflow 2016-17, would like to remain (parent must provide transportation)

☐ Site employee

☐

Employment in the area: _________________

☐

Siblings attend the school

School of Residence: School Requested: (mark one (1) school only) ___Desert Knolls Elementary (TK-6)

___Rancho Verde Elementary (TK-6)

___Sycamore Rocks Elementary (TK-6)

___Yucca Loma (TK-6)

___Mariana Academy (TK-8)

___Phoenix Academy (TK-8)

___Apple Valley HS ___________________ Program requested

___Granite Hills HS _________________ Program requested

APPROVAL IS GRANTED SUBJECT TO THE FOLLOWING CONDITIONS. I understand that this approval may be revoked at any time during the year if one or more of the following conditions are not met: 1. The parent will be responsible for the student's transportation. (Pursuant to Board Policy 5116.1) 2. The student will abide by school rules - including behavior, diligence and punctual attendance. 3. The student/teacher ratio is acceptable (the District participates in the Class Size Reduction program grades K-3). 4. The student will abide by the school’s uniform or dress code. SIGNATURE OF PARENT/GUARDIAN: SIGNATURE OF ACCEPTING SCHOOL ADMINISTRATOR: [ ] Approved

SIGNATURE SUPERINTENDENT OR DESIGNEE: [ ] Approved

DATE

[ ] Denied - Reason:

[ ] Denied - Reason:

DATE OF ENROLLMENT:

DATE