ROCKWALL ISD

TUITION-BASED LIMITED OPEN ENROLLMENT APPLICATION

Note: This form is for students who do not already live in the Rockwall district. If your student already resides within RISD and wants to transfer to another school within the district, you need to fill out the onlineStudent Transfer Application.

Please complete all necessary forms required for application (see Application Checklist). Incomplete application/forms will not be processed. Please read guidelines carefully prior to submitting application.

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Student Information:

Student Name: ______

Last First Middle

Student’s Home Address: ______

Street

______

CityStateZIP Code

Gender: Male Female Student’s Social Security #: ______

Student Date of Birth: ______(mm/dd/year)

Ethnicity: American Indian Asian Black Hispanic White

Is student in any special academic programs? Yes No

If you selected “Yes,” please explain:

______

______

______

Is student in any extra-curricular/athletic programs? Yes No

If you selected “Yes,” please explain:

______

______

______

Student’s Grade Level for 2017-2018: ______

School District where student currently resides: ______

Name of school student would attend in the district where the student resides if staying in that school district: ______

Address of school student would attend in the district where the student resides if staying in that school district: ______

Name of School where student attended 2016-2017 school year: ______

Campus requested in Rockwall ISD: ______

(Note: A list of schools closed to Tuition-Based Limited Open Enrollment is available in guidelines. Campus assignment will be based on campus enrollment, grade level capacity, and program capacity.Campus assignment will be made by the Superintendent or designee and may not be appealed.)

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Parent Information:

Parent Name: ______

Last First Middle

Parent’s Home Address: ______

Street (No P.O. Boxes)

______

CityStateZIP Code

Parent Home Phone #:______

Parent Cell Phone #: ______

Parent Work Phone #:______

Parent Email Address:______

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This section must be completed by parent or legal guardian of student:

Tuition for Limited Open Enrollment is $5,000/year and may be made in one payment to be made upon enrollment and prior to the student’s first day of attendance or in two, $2,500 payments to be made prior to the student’s first day of attendance each semester of the school year.

I have been informed of the receiving district’s policy concerning the nonrefundable tuition fee of $2,500per semester to be paid prior to the beginning of the semester, per year, per student. I also understand that a transfer may be denied and/or non-renewed by Rockwall ISD for, but not limited to, the following reasons as determined by Rockwall ISD:

  1. Disciplinary reasons (in school - or outside school)
  2. Excessive tardiness or absences
  3. Falsification of enrollment information
  4. Failure to provide timely transportation after school
  5. Failure to meet admission criteria in Tuition-Based Limited Open Enrollment Guidelines

By signing below, you are stating that the information provided on the application as well as the additional documents provided with the application as required are true and accurate to the best of your knowledge. You are also agreeing that you understand that falsification of any information provided will result in immediate denial of your application and/or removal from Rockwall ISD.

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Signature of Parent or Legal Guardian Date Printed Name of Parent or Legal Guardian

PLEASE SUBMIT COMPLETED APPLICATION, PAYMENT AND ALL ADDITIONAL REQUIRED DOCUMENTS TO THE ADMINISTRATIVE SERVICES DEPARTMENT AT 1050 WILLIAMS STREET, ROCKWALL, TEXAS

Administration Only:

This section must be completed by the office of the receiving District Superintendent:

The above transfer application was Approved Denied on this ______day of ______, 20____.

Campus assigned to attend:______

Signature of Superintendent or Designee:______Date:______

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