* =
required fields
For School Year:
2008-2009 2009-2010 2010-2011 2011-2012 2012-2013
1st Choice Building:
select one Addams Elementary Keller Elementary Northwood Elementary Oak Ridge Elementary Oakland Elementary Upton Elementary
2nd Choice Building:
select one Addams Elementary Keller Elementary Northwood Elementary Oak Ridge Elementary Oakland Elementary Upton Elementary
3rd Choice Building:
select one Addams Elementary Keller Elementary Northwood Elementary Oak Ridge Elementary Oakland Elementary Upton Elementary
Grade student will be entering: Pre K
1 2
3 4
5 6
7 8
9 10
11 12
Other
* Student Name:
First: Last:
Birthdate:
/ / (mm/dd/yyy)
Age:
Gender: Male: Female:
Parent/Guardian:
* E-mail Address:
* Address:
* City:
* State:
* Zip: xxxxx-xxxx
* Home Phone Number:
(xxx) xxx-xxxx
Work Phone Number:
Ext:
* School District of Residence:
* School Currently Attending:
Current School Address:
Current School City:
Current School State:
Zip:
If any siblings are enrolled or applying in the district, please list full name,
grade and building.
Sibling Name:
Sibling Status:
select one Enrolled Submitting Application
Building:
select one Royal Oak High School Royal Oak Middle School Addams Elementary Keller Elementary Northwood Elementary Oak Ridge Elementary Oakland Elementary Upton Elementary
Grade sibling will be entering: Pre K
1 2
3 4
5 6
7 8
9 10
11 12
Other
Has your child ever been suspended or expelled
from school during the past two years?
select one No Yes
(If yes, complete Attachment A )
Please explain:
Please check any special accommodations or services your child may require: (Check
Box)
Would you like to receive
information on the following programs: (Check
Box)
How were you informed of our
Schools of Choice Program:
Newspaper Radio TV
Signs Friend Other
I certify that the above
information is accurate and complete.