Submit form to the District where you live for approval.Nonresident Agreement • February 15th, 2017
Student's Last Name First Name Middle Name School Year Grade Student's Address Apt. No City, State, Zip Code Student Racial/Ethnicity (check one only) Student's birthdate Gender □ American Indian or Alaskan Native □ Asian or Pacific Islander □ Hispanic □ Black, not of Hispanic Origin □ White, not of Hispanic Origin Mo Day Year Male □ Female □ Parent or Guardian's Last Name First Name Middle Init. CellPhone: Work Phone: Home Phone: Parent's Address (if different from student) Apt. No City, State, Zip Code Reason this transfer is requested: SERVING School District Name District # School Student Would Attend Date Student Moved Has student been receivingSpecial Education Services? Cloquet 94 Mo Day Year □ Yes □ No RESIDENT School District Name District # School Student Last Attended Signature of Parent/Guardian / / The above information is true and correct to the best of my belief and knowledge. Date
NONRESIDENT AGREEMENTNonresident Agreement • September 29th, 2014
Student’s Last Name First Name Middle Name School Year Grade Student’s Address Apt. No. City Zip Code Student Racial/Ethnicity (Check one only)American Indian Asian oror Alaskan Native Pacific Islander Hispanic Black, not of White, not of Hispanic Origin Hispanic Origin Student’s Birthdate Gender M F Mo. Day Year Parent or Guardian Last Name(s) First Name(s) Middle Initial H:W: Phone(s) Parents Address (if dirrerent from Student’s) Apt. No. City Zip Code: Reason this transfer is requested: New Address SERVING School District Name Delano District Number879 School Student Would Attend Date Student Moved Has student been receiving Special Education Services?Yes No Mo Day Year RESIDENT School District Name DistrictNumber School Most RecentlyAttended Signature of Parent/Guardian The above information is true and correct to the best of my belief and knowledge. Date Signed
Nonresident Agreement Under Section 1127 of the New York City CharterNonresident Agreement • April 30th, 2018
Pursuant to the provisions of Section 1127 of the New York City Charter, I agree that if I am or become a nonresident, as defined in Section 11-1705 of the Administrative Code of the City of New York (see below) or any similar provisions of such Code at any time during my employment by NYC Health + Hospitals, the following conditions will apply:
Nonresident AgreementNonresident Agreement • November 3rd, 2014
Nonresident AgreementNonresident Agreement • January 17th, 2020
Student’s Last Name First Name Middle Name School Year Grade Student’s Address City Zip Code GenderM F Student Racial/Ethnicity (Check one only) American Indian Asian or Hispanic Black, not of White, not of Alaskan Native Pacific Islander Hispanic Origin Hispanic Origin Hispanic Origin Student’s Birthday Mo. Day Yr. Parent or Guardian: Last Name First Name Middle Initial Phone:H:W: Parent Address (if different from student’s) City Zip Code Reason this transfer is requested SERVING School District Name District No School Student Would Attend Date Student Moved Mo. Date Year RESIDENT School District Name District No. School Most Recently Attended Signature of Parent/Guardian X The above information is true and correct to the best of my belief and knowledge. Date Signed
Nonresident AgreementNonresident Agreement • April 1st, 2014
Student’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.
NONRESIDENT AGREEMENTNonresident Agreement • March 25th, 2022
Student’s Last Name First Name Middle Name School Year Grade Student’s Address Apt. No. City Zip Code Student Racial/Ethnicity (Check one only) Student’s Birthdate Gender M F American Indian Asian or Black, not of White, not of Mo. Day Year or Alaskan Native Pacific Islander Hispanic Hispanic Origin Hispanic Origin Parent or Guardian Last Name(s) First Name(s) Middle Initial Phone(s)H:W: Parents Address (if dirrerent from Student’s) Apt. No. City Zip Code: Reason this transfer is requested: New Address SERVING School District Name Watertown-Mayer Public Schools District Number#111 School Student Would Attend Date Student Moved Has student been receiving Special Education Services? Mo Day Year RESIDENT School District Name DistrictNumber School Most RecentlyAttended Signature of Parent/Guardian The above information is true and correct Date Signed to the best of my belief and knowledge.
Nonresident AgreementNonresident Agreement • August 20th, 2019
Student’s Last Name First Name Middle Name School Year Grade Student’s Address Apt. # City State Zip Code Student Racial/Ethnicity (Check only One) Student D.O.B. Gender American Indian Asian or Hispanic Black not of White, not ofOr Alaskan Native Pacific Islander Hispanic Origin Hispanic Origin Male Female□ □ □ □ □ □ □Parent/Guardian Last Name First Name Middle Initial Home Phone: Work Phone:Parent Address (If different from Student’s) Apt. # City State Zip Code Reason this transfer is requested:SERVING School District Name District # School Student Would Date Student Moved Has Student been receivingAttend MO DAY YR Special Education Services? □ YES □ NO RESIDENT School District Name District # School Most Recently Attended Signature of Parent/Guardian X The above information is correct to the best of my belief and knowledge. DATE
Nonresident AgreementNonresident Agreement • January 16th, 2018
Student’s Last Name First Name Middle Name School Year Grade Student’s Address City Zip Code GenderM F Student Racial/Ethnicity (Check one only) American Indian Asian or Hispanic Black, not of White, not of Alaskan Native Pacific Islander Hispanic Origin Hispanic Origin Hispanic Origin Stu dent’s Birthday Mo . Day Yr. Parent or Guardian: Last Name First Name Middle Initial Phone:H:W: Parent Address (if different from student’s) City Zip Code Reason this transfer is requested SERVING School District Name District No School Student Would Attend Date Student Moved Mo. Date Year RESIDENT School District Name District No. School Most Recently Attended Signature of Parent/Guardian X The above information is true and correct to the best of my belief and knowledge. Date Signed
NONRESIDENT AGREEMENTNonresident Agreement • September 15th, 2016
Student Racial/Ethnicity (Check one only) American Indian Asian or Black, not of White, not of or Alaskan Native Pacific Islander Hispanic Hispanic Origin Hispanic Origin Student’s Birthdate Gender M F
ST. CLAIR PUBLIC SCHOOLS NONRESIDENT AGREEMENTNonresident Agreement • August 7th, 2014
Student Last Name First Name Middle Initial School Yr 20 - 20 Grade Student Address City Zip Code Student Racial/Ethnicity (check one only) Student Birthdate MM/DD/YYYY Gender American or Asian or Hispanic Black, not White, not Alaska Native Pacific Islander Hispanic Origin Hispanic Origin Male Female Parent/Guardian Last Name First Name Middle Initial PhoneH:W: Parent Address (if different from student’s) City Zip Code Reason this transfer is requested: Military-Connected Youth YES NO Serving School District St. Clair Public School Dist. # 75 School Student Would Attend Effective Date of Transfer / / Handicap Services YES NO Resident School District Dist. # School Transferred From Signature of Parent/Guardian X The above information is true and correct to the best of my belief and knowledge.
Nonresident AgreementNonresident Agreement • September 18th, 2015
Student’s Last Name First Name Middle Name School Year Grade Student’s Address Apt. # City State Zip Code Student Racial/Ethnicity (Check only One) Student D.O.B. Gender American Indian Asian or Hispanic Black not of White, not ofOr Alaskan Native Pacific Islander Hispanic Origin Hispanic Origin Male Female□ □ □ □ □ □ □Parent/Guardian Last Name First Name Middle Initial Home Phone: Work Phone:Parent Address (If different from Student’s) Apt. # City State Zip Code Reason this transfer is requested:SERVING School District Name District # School Student Would Date Student Moved Has Student been receivingAttend MO DAY YR Special Education Services? □ YES □ NO RESIDENT School District Name District # School Most Recently Attended Signature of Parent/Guardian X The above information is correct to the best of my belief and knowledge. DATE
