Attend Area Exception Form_Attend Area Exception Form
Kimberly Area School District
School Request Form Clear Form
One Form Per Child Please
Request for School Year _____________
Student Last Name
Current Grade
Student First Name
Street Address
State
City
Assigned School:
JAN
SUN
WES
WDL
MAP
Mother_______________________________
Zip Code
Desired School:
JAN
Home Phone
SUN
WES
WDL
MAP
Father______________________________
Work Phone________________________________
Work Phone_______________________________
Cell Phone_________________________________
Cell Phone________________________________
email address:______________________________
email address:______________________________
Student has IEP: Yes No Reason Requesting Change: –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Parent Signature _______________________________________ Date___________________ PRINT FORM
Please understand: If your child currently is a bus student and your request is approved, the Kimberly Area School District will no longer be responsible to provide student transportation. Return to: Supt. Robert S. Mayfield, Ed.D., 425 S Washington St., Combined Locks WI 54113 or FAX 920-788-7919 or email to: [email protected] with a subject line of "SCHOOL REQUEST"
Request Approved
Signed_______________Date:____________
Request Denied
School Request Form Clear Form
One Form Per Child Please
Request for School Year _____________
Student Last Name
Current Grade
Student First Name
Street Address
State
City
Assigned School:
JAN
SUN
WES
WDL
MAP
Mother_______________________________
Zip Code
Desired School:
JAN
Home Phone
SUN
WES
WDL
MAP
Father______________________________
Work Phone________________________________
Work Phone_______________________________
Cell Phone_________________________________
Cell Phone________________________________
email address:______________________________
email address:______________________________
Student has IEP: Yes No Reason Requesting Change: –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Parent Signature _______________________________________ Date___________________ PRINT FORM
Please understand: If your child currently is a bus student and your request is approved, the Kimberly Area School District will no longer be responsible to provide student transportation. Return to: Supt. Robert S. Mayfield, Ed.D., 425 S Washington St., Combined Locks WI 54113 or FAX 920-788-7919 or email to: [email protected] with a subject line of "SCHOOL REQUEST"
Request Approved
Signed_______________Date:____________
Request Denied
