South lyon community schools

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SOUTH LYON COMMUNITY SCHOOLS

Nonresident Schools of Choice Application Grades K-9

2014-2015 School Year – 2^nd Semester only

Please fill out completely

Student Name

Last First Middle

Birth Date Entering Grade (2014-2015 school year)

Parent/Guardian

Name Address City Zip Code

Telephone

Home Cell Work

Parent E-mail address______________________________________________________________________________

Does the student have a parent who resides in the South Lyon Community School District? Yes No

Student’s current school and district____________________________________________________________________

Address of school district_____________________________________________________________________________

Telephone________________________________________________________________________________________

Public school district of residence if different from above____________________________________________________

The following section must be completed.
Has the student been suspended from school within the last two (2) years? _____Yes _____No

Has the student ever been expelled from school or convicted of a felony? _____Yes _____ No

If yes, give details below.

Date____________________ Reason__________________________________________________________________

For Out of County Applicants Only – Does your child receive Special Education Services? Yes_____ No_____

Type of Special Education program_________________________________
(Attach another page if more space is needed for explanation)

Note: Not all buildings will have space in all grades for Schools of Choice students, therefore, please indicate your preferences.

1^st Choice________________________________________ 2^nd Choice________________________________________ No Preference______

By signing below, I certify that all of the information provided above to be true and I acknowledge and accept the policies and stipulations of South Lyon Community Schools’ Schools of Choice program. I understand untrue or incomplete information will disqualify and remove the applicant from South Lyon Community Schools’ program. I give permission to South Lyon Community Schools to contact my student’s previous school regarding their school record.
Parent/Guardian Signature__________________________________________________ Date__________________________________________

Central Office

Building Placement:_________________________________________________________________________________________________________

School District Administration: Approved__________ Denied__________ 105__________ 105c__________

Return to: South Lyon Community Schools

Pupil Services Office – Attn: Mariann Martin Phone 248-573-8134

Or scan and email: 345 South Warren

martinm@slcs.us South Lyon, MI 48178 or Fax # (248) 437-8120

Applications being taken January 12, 205 through January 26, 2015 for 2^nd Semester only 2014-2015 school year

2014-2015SOC app2nd 1/9/15 mm