Out Of Area School Request

Talbot County Public Schools
2018-19 School Year - Deadline for submission of new requests is June 1, 2018.

Student must be enrolled in required TCPS attendance zone school prior to submitting application if this is an initial request. Applications submitted after June 1st will not be accepted unless the student is new to TCPS or there is a bona fide emergency or event that could not have been foreseen prior to June 1st. Childcare information/verification must be complete if that is the reason for the request. Applications must be submitted and renewed yearly for continued attendance out of area. Continued approval is not guaranteed from year to year.

*** Transportation to and from school will be your responsibility. ***

Select School Year For This Request *
2017-2018 2018-2019
Type of request *
new renewal
Student Name * Title First Middle Last Suffix
Student Date of Birth * / MM / DD YYYY
Grade entering *
Child's Street Address (where the child resides) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Does your child receive Special Education services? *
Yes No
Does your child have a 504 plan? *
Yes No
Mother/Guardian Name * Title First Middle Last Suffix
Mother/Guardian's Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mother/Guardian's Phone Number - ### - ### ####
Mother/Guardian's Email Address *
Father/Guardian Name * Title First Middle Last Suffix
Father/Guardian Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Father/Guardian's Phone Number * - ### - ### ####
Father/Guardian's Email Address *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone * - ### - ### ####
Reason for Request: *
Student's Assigned Home School: *
CDES EES - D EES - M SMES TES WMES EMS SMMHS EHS Out of County
Out of Area School you would like you child to attend: *
Chapel District Elementary School Easton Elementary School - Dobson Easton Elementary School - Moton St. Michaels Elementary School Tilghman Elementary School White Marsh Elementary School Easton Middle School St. Michaels Middle High School Easton High School
Please select if applicable. *
Tuition Student TCPS Staff Not applicable
Childcare Verification

Name of person providing care:
(must be completed if this is the reason for the request) Title First Middle Last Suffix
Phone number of person providing care:
(must be completed if this is the reason for the request) - ### - ### ####
Address of person providing care:
(must be completed if this is the reason for the request)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
PLEASE READ BEFORE SIGNING:

It is the intention of the Board of Education to further study enrollment trends. If it is necessary to change policy for next year, an early decision will be made to allow adequate planning. Please review Policy 10.10 and 10.10 AR for additional information.

TRANSPORTATION TO AND FROM SCHOOL WILL BE YOUR RESPONSIBILITY.

I hereby declare and affirm under penalties of perjury that the information provided above is true and correct to the best of my information, knowledge, and belief. I understand and agree that if false information of provided, the out-of-zone placement will be denied or revoked.
PARENT VERIFICATION: Draw your signature into the box below. *

Clear
Today's Date * / MM / DD YYYY

Out Of Area School Request

Out Of Area School Request

PLEASE READ BEFORE SIGNING: