APPLICATION FOR ENROLLMENT OPTIONS ED-01861-21-

279
IN OSSEO AREA SCHOOLS 12-21-05

GENERAL INFORMATION: INSTRUCTIONS:

Kindergarten through twelfth grade students and pre-
kindergarten children with disabilities may apply to attend a
public school outside of their resident district (Minn. Stat. §
124D.03). Residents of District 279 may apply to attend a
school other than their assigned school.
School and program information may be requested from
districts or schools. Information about school districts,
schools and school programs is also available on the
Minnesota Department of Education’s Web Site at
http://education.state.mn.us
Applications to attend Osseo Area Schools are subject to School Board
Policy 558 – Enrollment Options. Information about Osseo Area
Schools and School Board policies is available online at
www.district279.org.
Once you decide to apply, you must inform the school your child is
currently attending that you are applying to a non-resident district for
enrollment. Use one application for each student.
1. Complete Section 1 and sign Section 2.
2. Send the completed application to
Enrollment Center
7051 Brooklyn Boulevard
Brooklyn Center, MN 55429
FAX: (763) 585-7368

SECTION 1: TO BE COMPLETED BY THE STUDENT’S PARENT OR GUARDIAN

Student Name (Last, First, M.I.) Birthdate (MM/DD/YY) Gender
M F
Student Address (if different than parent/guardian address)

School Currently Attending or Last Attended Grade (as of today’s date) Special Needs (optional)

Parent/Guardian Name (Last, First, M.I.) Telephone Number

Home ( ) - Cell ( ) -
Work: ( ) -

Parent/Guardian Address City/State/Zip Code

Resident District, if other than ISD 279 Osseo Area Schools City

District of Choice
I.S.D. 279 - Osseo Area Schools
Reason for Request (This does not affect authorization of this request.) List requested school(s) choice(s) in order of priority
1. ___________________________________________________

2. ___________________________________________________
Requested Student Enrollment Start Date
3. ___________________________________________________
Is the student currently expelled from any school district for
Possession of a dangerous weapon? No Yes
Possessing, using, selling, or soliciting the sale of an illegal drug or controlled substance? No Yes
Committing a third-degree assault? No Yes
If you answer yes to any of these questions, the District will not authorize your application.

Per School Board Policy 558, enrollment may be terminated if a student is truant from school.

SECTION 2: PARENT/GUARDIAN VERIFICATION OF INFORMATION

1. I hereby verify that the above information is true and correct to the best of my knowledge and belief. I understand that
falsification of information on this document will result in termination of the enrollment agreement.
2. I understand that upon authorization, my child is obligated to attend the requested school, and in order to return to the
resident building or to attend a different school, a new application must be submitted and authorized.
3. My signature on this application serves as my notification to the Osseo Area Schools that upon authorization, my child
will enroll at the school I have requested during the requested school year.

_________________________________________________________________________ _________________________________
Signature – Parent/Guardian Date