A copy of this form should be provided to the school district of residence. Effective 2015-2016 School Year Application for Out-Of-District1 School Attendance and Transportation To: Board of Education - USD No. (Receiving School District) I, the parent of: Studerrtlj^Legal Name ^^'iV'") S-c*^ Gender: C~Ma Ie) Female Last Name c?0t^(-1^ Hn^A^ux '^t-. '','-^/;D^ County ^ansgs ;/;/ i' u lr •: <^ a First Nd -^^ ^i\ Student's Legal Name CT I b S c^~T\ Gender: Male Female Student's Legal Name Gender: Male Female Last Name C^rl^i qly Grade in 2015-16 T^ 2^ First Name Last Name First Name Student's Legal Name Gender: Male Female First Name Grade in 2015-16 Grade in 2015-16 Grade in 2015-16 Last Name hereby certify that my child(ren) and I are residents ofU.S. D. No ?~^<^0 and we reside 2 Vz or more miles from the attendance center my child or children would attend in U.S.D. No. L\3C) • Therefore, under K.S.A. 72-1046b, I hereby apply for authority for my child(ren) named above to attend school in U.S.D. No.(-.V\0 (Receiving School District) and to be furnished or provided transportation to and from school by the Receiving School District for the 2015-2016 school year. '"fc, t (^ r?-l3> 16 Date Signature - Parent/Legal Guardian Parent/Legal Guardian Name: (j\^) <^4" Tji '^'J\/s O-i l;^<:Sfy' Printed or type< Address: [^ QQ^ f^S ^ fc.J j/ 16°," City St Zip: ^ ^4-/^p ^ ^ (^ (^ ^ cj ^ i3-0-<-<-^ Official Signature - RECEIVING School District ^- //-^6 Date Acknowledgment Official Signature - School District of Residence Date b\v:2015'outdistr fonn Not for school districts with territory in Johnson, Sedgwick, Shawnee or Wyandotte counties. 2 T-I.; This form must be resubmitted every year.
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First Nd Hn^A^ux T^ 2^ C^rl^i qly · am (2 Last Name First Name Last Name First Name Last Name First Name Grade in 2015-16 Grade in 2015-16 Grade in 2015-16 Last Name First Name Grade
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A copy of this form should be provided to the school district of residence.
Effective 2015-2016 School Year
Application forOut-Of-District1 School Attendance and Transportation
To: Board of Education - USD No.
(Receiving School District)
I, the parent of:
Studerrtlj^Legal Name ^^'iV'") S-c*^Gender: C~Ma Ie) Female Last Name
c?0t^(-1^
Hn^A^ux'^t-. '','-^/;D^
County ^ansgs
;/;/ i' u lr •:
<^ aFirst Nd-^^ ^i\
Student's Legal Name CT I b S c^~T\Gender: Male Female
Student's Legal Name
Gender: Male Female
Last NameC^rl^i qly
Grade in 2015-16
T^2^First Name
Last Name First Name
Student's Legal Name
Gender: Male Female First Name
Grade in 2015-16
Grade in 2015-16
Grade in 2015-16Last Name
hereby certify that my child(ren) and I are residents ofU.S. D. No ?~^<^0 and we reside 2 Vz or more miles
from the attendance center my child or children would attend in U.S.D. No. L\3C) •
Therefore, under K.S.A. 72-1046b, I hereby apply for authority for my child(ren) named above to attend school in
U.S.D. No.(-.V\0 (Receiving School District) and to be furnished or provided transportation to and from
school by the Receiving School District for the 2015-2016 school year.'"fc,