Crowley County School District Re 1-J
Out-of-District Student Request
Parent Information:
Parent’s Name:
Home Address:
Home Phone:
Alternative Phone:
Student Information:
Student Information
Current Age
Anticipated grade for the
school year
Previous School:
Address:
Has your child been denied admission in their current school of residence or any other school because of
violations of state law or code(s) of conduct?
Yes _____ No _____
Has your child been expelled from their present or previous school?
Explain:
Yes _____ No _____
Is your child/children on an IEP/504 Plan from their previous school(s)?
Explain:
Yes _____ No _____
Does your child have any special health needs?
Explain:
Yes _____ No _____
(For Office Use Only)
Date received:
Date verified with previous school:
Verified by:
Approved by Superintendent:
Approved by Board:
Crowley County School District Re 1-J
Out-of-District Student Request
I hereby certify that all information on this request for my children is true, accurate and complete. Any
misrepresentation or willful omissions of facts shall be sufficient cause for disqualification of the
application – at any time.
I hereby authorize the district or district representative to conduct an educational reference check to
verify statements and information on the application form.
The Crowley County School District reserves the right to refuse an out-of-district parent request when
the addition of out-of-district students would create a financial burden on the district and/or a special
needs student would exceed the limit of our capacity to meet the needs of special education students.
Resolution #2004-09
Parent(s) Signature
Date
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