first nd hnâûx t^ 2^ c^rlî qly · am (2 last name first name last name first name last name...

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^

HnÂûx'^t-. '','-^/;D^

County ânsgs

;/;/ i' u lr •:

<^ aFirst Nd-^^ î\

Student's Legal Name CT I b S c^~T\Gender: Male Female

Student's Legal Name

Gender: Male Female

Last NameC^rlî qly

Grade in 2015-16

T^2^First Name

Last Name First 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,

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

^- //-^6Date

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.




To: Board of Education-USD No. ^ ^ ) ti+PJj^'.-SG>1^\ County, Kansas


I, the parent of:

Student's Legal Name Or"l-£/^ ^ f <^Gender: Male Female

Student's Legal Name H^fol ^ <^

Last Name

ârr-di-First Name

~^Lâ r..

1^

Gender: Male Female


Gender; Male Female


Gender: Male Female



Grade in 2015-16

[^Grade in 2015-16

Grade in 2015-16

Grade in 2015-16Last Name First Name

hereby certify that my child(ren) and I are residents ofU.S. D. No. ^ / { and we reside 2 '/2 or more miles

from the attendance center my child or children would attend in U.S.D. No. 37^'


U.S.D. No. U <5Q (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.

-(/n^°^J.& r>^y\•1-£MS-Date Signature - Parent/Legal Guardian

Parent/Legal Guardian Name: ^\^-\ \ P^CL fvV-€-^J)^^Printed or typed

Address: \[3^r) And^5<3A {^

city st zip: \A^CZA-o^ , ^S . /^-^

Authority

eî(~4 cs^rc-^s


^ //-^(6Date

Acknowledgment


Date

b\v:2015outdistr form

Not for school districts with territory in Jolinson, Sedgwick, Sliawnee or Wyandotte counties.

This form must be resubmitteci every year.




To: Board of Education - USD No. "-

(Receiving School District)A^.»so^\ County, Kansas

li'!' •('-'-ij

I, the parent of:


Gender: i^K/lale} Female


Gender: Male Female


Gender: Male Female


Gender: Male Female

\0 I? Un,

< /1 I _ ilLb(€L"am (2




Grade in 2015-16

Grade in 2015-16

Grade in 2015-16

Grade in 2015-16Last Name First Name

hereby certify that my child(ren) and I are residents of U.S. D. No. ^) I I and we reside 2 1/2 or more miles

from the attendance center my child or children would attend in U.S.D. No. .37 7 .


U.S.D. No. 1-\^}V (Receiving School District) and to be furnished or provided transportation to and from


r/^ ^ /^Date

Parent/Legal Guardian Name:

Address:

City St Zip:

Signattire^.PareiWLegal Guyrd(aj

.'u 'OL^=Printed or typed

^0 Zo ' 350^ 7?cv^f^o^ro/0 ~K^ (fc^/3f

<a-o-<-^-<»


^~ /l-W^Date

Acknowledgment


Date

b\v:2015-'outdislr form

Not for school districts with territory in Johnson, Sedgwick, Shawnee or Wyandotte counties.

' This form must be resubinitted every year.

HEGBVE0

m 1 § 28%

Rli^R ^TT



Application forOut-Of-District1 School Attendance and Transportation2

To: Board of Education - USD No. / J/?> d '^\r\ {^\ </s~\\ i~\\^\ County, Kansas


I, the parent of:

Student's Legal Name ^s>r<~^ \/ (^ |~Gender ^le'f) Female


Gender: Male Female


Gender: Male Female


Gender: Male Female

Last Name\QJ^

First Nam-y



Grade in 2015-16

Grade in 2015-16

Grade in 2015-16

Last Name First Name Grade in 2015-16

hereby certify that my child(ren) and I are residents ofU.S. D. No. -^\—/ / and we reside 2 '/2 or more miles

from the attendance center my child or children would attend in U.S.D. No. ^ / / .


U.S.D. No. L-^.^tJ (Receiving School District) and to be furnished or provided transportation to and from


/o-R'-l^ -̂mTVur^Signature - Parent/Legal Guardian

lrr\v^-

Parent/Legal Guardian Name: (~^(\ t\ G,>(t\^t^ YrY\\'(J H-Printefl or typed

Address: ^^--] "3S^ ftd .

city St zip: ^rw-f^vn, t<5. Lf)L.p46ci

e«-o-c-<-^


^- fl-w^Date

Acknowledgment


Date

b\v;2015'outdistr form


This fonn must be resubmitted every year.




To: Board of Education - USD No.


I, the parent of:

Student's Legal J^ame 'ROoVV'Gender Male

A-\pVucin^ Couta'ty^Kiansaji V |^ (.!'

Last Name


Gender: Male /^"Female

<X}^Last Name


Gender: Male Female


Gender: Male Female

Last Name

^Ta^\orFirst Nami

.'\)<?.U'ncFirst Name

First Name

First Name

i p "o'sr'u

;0 ^'^

Grade in 2015-16

^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. <3'?/1 and we reside 2 Vi or more miles

from the attendance center my child or children would attend in U.S.D. No. <3rlr\ •


U.S.D. No. ^30 (Receiving School District) and to be furnished or provided transportation to and from


/n-15-15 JIAT. fn^Date Signature - Parent/Legal Guardian

Parent/Legal Guardian Name: '^\CQ^XPrinted or typed

Address: ^55^ U5 ftLQ^ )5^City St Zip: J-WW, ^ ^&^3<:?

e3^{j-<-^^


^- //-^{^Date

Acknowledgment


Date

b\v:2015 ouldistr fonn

Not for school districts with territory in Johnson, Sedgwick, Shawnee or Wyandotte counties.2 T-l.;Tins form must be resubmitteci every year.




To: Board of Education - USD No. ^2, ^


I, the parent of:

iXo^crn County, Kansas


Gender: Male Female


Gender: Male Female


Gender: Male Female


Gender: Male Female

aUe-n M^Ql 6'^Last Name First Name Grade in 2015-16

a ner>Last Name

[A'jli^m ^ ^First Name



Grade in 2015-16

Grade in 2015-16

Grade in 2015-16

and we reside 2 '/2 or more mileshereby certify that my child(ren) and I are residents ofU.S. D. No. ,-?TT and we

from the attendance center my child or children would attend in U.S.D. No. 1~\ -> ^ .


U.S.D. No. (-1,?U (Receiving School District) and to be furnished or provided transportation to and from


b'^n-KDate Signature - Pare;

(j^m

Parent/Legal Guardian Name: Ô^L\H L. ft U ÛPrinted or typed

Address: {^// f/ ,f /^j</ /Sf

city St zip: j-krj'T)Y]^ /"5< l^^l^

Authority

eîL4̂R{.

i3^0-<-<-^


^ //-Ôi^Date

Acknowledgment


Date

b\v:2015'outdistr fonn


This form must be resubmitteci every year.

first nd hnâûx t^ 2^ c^rlî qly · am (2 last name first name last name first name last name...

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