School of Choice

School of Choice 105 and 105c

Student's Name:

Date of Birth

Grade applying for:

Last grade completed:

Parent(s)/Guardian:

Address Line 1

City

State

Phone:

Zip

Email Address

Special Education Services Required? (required) Yes No

Any Suspensions or Expulsions? (required) Yes No

Previous School District (last two years)

Previous School District Building:

Resident School District (if different than last district)

What are your reasons for wanting to attend C-S?

Are there any siblings that will also be attending C-S? (required) Yes No

Second Sibling's Name

Second Sibling's Date of Birth:

Last grade second sibling completed:

Grade second sibling is applying for:

Are Special Education Services required for second sibling? Yes No

Any Suspensions or Expulsions? (second sibling) Yes No

Third Sibling's Name:

Third Sibling's Date of Birth:

Last grade third sibling completed:

Grade third sibling is applying for:

Are Special Education Services required for third sibling? Yes No

Any Suspensions or Expulsions? (third sibling) Yes No

Do you have relatives currently living in the Climax-Scotts Community School District? Yes No

Name:

Address:

City/Zip

Please provide a copy of a Birth Certificate and an up-to-date immunization record for each student listed above:

*Special Note: The provisions of Section 105 have no effect on the Michigan High School Athletic Association (MHSAA) rules. Section 105 schools of choice pupils are considered nonresident pupils and, at MHSAA member high schools, are ineligible for interscholastic athletics for one full semester. REF: Section 105 schools of choice, 1996.

Final Consents and Acknowledgements

By checking this box, I acknowledge that all of the information above is true and that I am giving permission for records pertaining to the applicant(s) to be released to Climax-Scotts Community Schools. In addition, it indicates an understanding that transportation will be the responsibility of the student's parent(s)/legal guardian(s). (required)

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School of Choice

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