SCHOOLS OF CHOICE APPLICATION FORM

2011-2012 School Year

(Completed application form must be returned to the Superintendent's Office by June 15, 2011.  A separate application form must be completed for each student desiring to attend the Bridgman Public Schools under the Schools of Choice State Aid Act of 1996, P.A. 300, Section 105.)

Name of Student _____________________________________________

Permanent Address of Student _____________________________________________
(Also include mailing address
if different) _____________________________________________

Home Telephone # of Student _____________________________________________

Student's Date of Birth _____________________________________________

Student's Resident School District _____________________________________________

Grade Level being Requested _____________________________________________
(Note for high school students: credit requirements for grade level must be met according to BHS policies)

Name(s) of Parent(s)/Legal Guardian _____________________________________________

Address of Parent(s)/Legal Guardian _____________________________________________

                                                        _____________________________________________

Work Telephone # of Parent(s)/Legal _____________________________________________
Guardian

Please circle answer:

1. Has the student ever been expelled from another school? If yes,                          Yes   No    
please explain:
_______________________________________________________
_______________________________________________________

2. Has the student been suspended from another school during the                           Yes   No
preceding two (2) school years? If yes, please explain:
_______________________________________________________
_______________________________________________________

3. Has the student been truant or had attendance problems at another                      Yes   No
school during the preceding two (2) years? If yes, please explain:
_______________________________________________________
_______________________________________________________

4. It is understood that a 9th grade student will be athletically eligible                      Yes   No
to participate in sports according to M.H.S.A.A. rules. 10th, 11th
and 12th grade students are athletically ineligible for one (1) full
semester according to M.H.S.A.A. rules.

5. Was the applicant enrolled in a previous school year in Bridgman                        Yes   No
Public Schools?

6. Did the applicant receive special education service(s) the previous                      Yes   No
school year? If so, please list service(s):______________________                     

7. Does the applicant have a brother/sister already attending Bridgman                    Yes   No
Public Schools under the Schools of Choice Program? If so, please
list name(s) and grade(s): _________________________________
_____________________________________________________

8. It is understood that the student will only be eligible for transportation                  Yes   No
services outside the Bridgman Public School District at specifically

designated bus stops. (The student may receive transportation from any

pick up/delivery point within the Bridgman Public School District.)

9. It is understood that the student will adhere to the attendance policies                  Yes   No
that are written in the student handbooks and that tardies/absences will
not be excused because of lack of transportation or weather conditions.

As the parent(s)/legal guardian making application for Schools of Choice under State Aid Act of 1996, P.A. 300, Section 105, my/our signature(s) on this application signifies my/our understanding and agreement to theSchools of Choice language and guidelines and to all rules and regulations of student handbooks. If accepted, I/we shall provide the transportation for my/our child to the school he/she will be attending or to a regular school bus stop within the school district or to a specifically designated bus stop outside the district. It is also understood that if the Bridgman Public Schools find any information that is incorrect or falsified on this application, that this would immediately terminate enrollment of the student on this form. My/Our signature(s) also holds harmless the Bridgman Public Schools, their employees, and Board of Education members for any decisions made relative to the Schools of Choice language and guidelines.

Signature(s) of Parent(s)/Legal Guardian

_________________________________________          _________________________________________

Date _____________________________________

- - - - - - - - - - - - - - - (To be completed by an official of Bridgman Public Schools) - - - - - - - - - - - - - - - -

Date Application Received ________________________________________

Request is: Granted _____________ Denied ______________

Date Letter of Notification sent to Parent(s)/Legal Guardian: ________________________

Date Request of Student Records Sent: ________________ Name of School ____________________