File:  JEC-R-F1

 

ALLEGHANY COUNTY PUBLIC SCHOOLS

Annual Application for Non-Resident/Non-District Students

 

 

 

 

 

______________________________________________________                               School year:  2018-2019

Name of requested school

                                                                                                                                                  

____________________________________________________________________________________________

Student’s full name                                           Age                               Birthdate                     Grade level for 2018-2019

 

____________________________________________________________________________________________

Student’s current legal residence (city/county)*                                                    What school should student attend?

 

_________________________________________________________                      ___________________________

Name of legal parent/guardian                                                                                       Telephone number

 

____________________________________________________________________________________________

Mailing Address (if different than residence)                        City                                                                   Zip code

 

Your reason for this request ______________________________________________________________________

____________________________________________________________________________________________

I understand that if my child fails to fulfill his/her obligations to all policies, regulations and/or guidelines of Alleghany County Public Schools, or if my child is no longer able to participate in the program or school to which he/she has been admitted,  the Superintendent/Designee may terminate acceptance of this application.  In such a case, I assume responsibility to return my child to his/her home school district. I also understand that I must assume responsibility for transportation of my child to school.

 

 

______________________________________________________                  ____________________

Signature of legal parent/guardian                                                                                  Date

 

To be completed by school principal or designee.

 

School student attended 2017-2018:______________________________________________________________

 

Summary of attendance, including reasons and tardies, academics, and discipline:_________________________

___________________________________________________________________________________________

 

___________________________________________________________________________________________

 

___________________________________________________________________________________________

 

Recommendation of Principal / Designee:   _______Accept                   _______ Deny

 

Signature of Principal / Designee  _____________________________________________  Date ______________

 

Recommendation of Superintendent/Designee:     _______Accept          _______Deny

 

Signature of Superintendent/Designee:  _______________________________________    Date­­­­­­­­­­­­­­­­­­­­_______________

 

 

*The Alleghany County School Board does not discriminate on the basis of race, color, national origin, sex, political affiliation, disability, or age in its programs and activities.  The following have been designated as the contact regarding compliance issues associated with this non-discrimination policy and compliance with Title IX:  Director of Human Resources and Pupil Personnel and Director of Assessment and Accountability.  For questions and compliance with Section 504 and ADA contact the Director of Special Education.  Alleghany County School Board Office, 100 Central Circle/P.O. Drawer 140, Low Moor, Virginia 24457. 540-863-1800.

 

*Any person who knowingly makes a false statement concerning the residency of a child, as determined by § 22.1-3, in a particular school division or school attendance zone, for the purpose of (i) avoiding the tuition charges authorized by § 22.1-5 or (ii) enrollment in a school outside the attendance zone in which the student resides, shall be guilty of a Class 4 misdemeanor. (§ 22.1-264.1)  This application shall be submitted annually and parents/guardians will be notified in writing by July 7, 2017.