Open Enrollment

APPLICATION FOR RESIDENT AND NON-RESIDENT STUDENTS
2009-10 School Year

Special Education Students. If your child has qualified or received special education services within the past three years including Speech/Language  services, please submit current IEP, and current evaluation to the Kyrene School District Office, 8700 S. Kyrene Rd. Tempe, AZ 85284 or fax to 480-783-4055 Attn: Open Enrollment.

Fill out and submit a separate form for each child.

Student Name and Information:

First:    Middle:    Last:

Birth Date (mm/dd/yy): 

Current grade level:        Select Here Preschool K 1 2 3 4 5 6 7              2009-2010 grade level:  Select Here Full Day K Half Day K 1 2 3 4 5 6 7 8  

Comments (optional):

Boundary Information:

2008-2009 School of Attendance:

Child resides outside Kyrene School District. List current school district (School, City, State)

Choose previously attended Kyrene School? (Required field).

Select School Here Not Kyrene or Not Yet In School Elementary - C.I. Waggoner Elementary - Kyrene de las Brisas Elementary - Kyrene de los Cerritos Elementary - Kyrene del Cielo Elementary - Kyrene de la Colina Elementary - Kyrene de la Esperanza Elementary - Kyrene de la Estrella Elementary - Kyrene de los Lagos Elementary - Kyrene de las Lomas Elementary - Kyrene de las Manitas Elementary - Kyrene de la Mariposa Elementary - Kyrene del Milenio Elementary - Kyrene de la Mirada Elementary - Kyrene Monte Vista Elementary - Kyrene de los Ninos Elementary - Kyrene del Norte Elementary - Kyrene de la Paloma Elementary - Kyrene de la Sierra Elementary - Kyrene del Sureno Middle School - Kyrene Akimel A-al Middle School - Kyrene Altadena Middle School - Kyrene Aprende Middle School - Kyrene Centennial Middle School - Kyrene Middle School (KMS) Middle School - Kyrene del Pueblo                                      

Child has a parent/guardian that is employed by Kyrene School District. Location of employment.

Child has a sibling that is currently enrolled in the requested school. List sibling's name.                    

School Selection: (Please select your school of choice.)

Reason(s) for choosing Kyrene: Please rank according to the importance of your choice.
(This information is not used to determine placement

Primary reason

Select Here Previously attended Kyrene Employee of Kyrene Problems with current school Kyrene provides childcare Childcare provider lives in district Kyrene's reputation Kyrene's programs Location (eg. near work) Moved into/out of district

 Secondary reason

Select Here Previously attended Kyrene Employee of Kyrene Problems with current school Kyrene provides childcare Childcare provider lives in district Kyrene's reputation Kyrene's programs Location (eg. near work) Moved into/out of district  

 Third reason

Select Here Previously attended Kyrene Employee of Kyrene Problems with current school Kyrene provides childcare Childcare provider lives in district Kyrene's reputation Kyrene's programs Location (eg. near work) Moved into/out of district  

Please note how you learned of Kyrene School District:

Select Here Internet Search Signage/Poster Ad Advertisement District Website Realtor District Publication Word of Mouth (This information is not used to determine placement.)

Has the student named above been:

• Expelled or long term suspended, or currently being considered for expulsion or long term suspension from any school or district?     Yes/No Yes No

• In compliance with conditions imposed by a juvenile court?  Yes/No Yes No NA

• Receiving or qualified for gifted services?  Yes/No Yes No NA

• Currently receiving or qualified for special education services including Speech/Language or has received such services within the past 3 years?  Yes/No Yes No NA

Parent/Guardian Information:

First:    Middle:     Last:

Home Address:

Street:     City:   State:   Zip:

Home Phone:   Work Phone:   Cell Phone/Pager:  

Email:

 The following conditions apply to the open enrollment program

Select Here I AGREE   By selecting "I AGREE" I understand that if the information on this application is not truthful and accurate, the district has the right to revoke the student's open enrollment status.

• If your child's grade or program is at capacity at the school you have chosen, we will work with you to find another school that has room or, if you prefer, will put your child's name on a waitlist.

• Transportation for all open enrollment students is the responsibility of the parent or guardian.

• Applicants must follow all rules and regulations of the receiving school as outlined in the student/family handbook, including standards for homework, student conduct, and attendance.

• Kyrene School District does not accept students from districts with agreements or court orders regarding desegregation unless accompanied by a letter of release from district of residence.

• Falsification or withholding of any information will result in revocation of open enrollment status.

For specifics see Kyrene School District Open Enrollment Policy JFB