Nonresident AgreementNonresident Agreement • April 1st, 2014
Contract Type FiledApril 1st, 2014Student’s Last Name First Name Middle Name School Year Grade Student’s Address Apt. No. City Zip Code Student Racial/Ethnicity (Check all that apply)□ American Indian □ Asian oror Alaskan Native Pacific Islander □ Hispanic □ Black, not ofHispanic Origin □ White, not of Hispanic Origin Student’s Birthdate Gender□ M□ F Parent or Guardian: Last Name First Name Middle Initial Phone NumbersH:W: Parent Address (if different from student’s) Apt. No. City Zip Code Reason this transfer is requested: SERVING School District Name District Number School Student Would Attend Date Student Moved Has student been receiving Special Education Services? □ YES □ NO RESIDENT School District Name District Number School Most Recently Attended Signature of Parent/GuardianX The above information is true and Date Signed correct to the best of my belief and knowledge.