Edwardsburg Public Schools - Out of State Tuition Form
Non-Resident Students Requesting Enrollment into
Edwardsburg Public School District
2021-2022

To enable a non-resident tuition student to enter/continue at Edwardsburg Public Schools, advanced approval of the following persons must be obtained:

1. Superintendent of receiving school district
2. Building administrator of receiving district
3. Parent or guardian of student, if applicable
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Email *
Please select one: *
Student's Last Name *
Student's First Name *
Student's Date of Birth *
MM
/
DD
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YYYY
Parent's Name *
Parent Home or Mobile Phone Number (please use format XXX-XXX-XXXX) *
Parent Work Phone: (please use format XXX-XXX-XXXX) *
Address: *
City *
State *
Zip Code *
School district of residence: *
School district of residence phone number:
School currently attending: *
School currently attending phone number:
Reason for request: *
School desired in Edwardsburg Public School District *
Grade Student entering 2021-2022 *
SIBLING(S) APPLYING/CURRENTLY ATTENDING
Sibling #1 Name:
Sibling #1 Grade:
Sibling #2 Name:
Sibling #2 Grade:
Has student ever been EXPELLED from school? *
If yes, how long?
State reasons:
Does student have a criminal record? *
If yes, state offense:
Name of county and court which has jurisdiction:
Sentence:
Is student currently under court jurisdiction? *
If yes, how long?
SERVICES
Does/Has this student receive(d) special education programs, services or accommodations?   *
If yes, please explain briefly:
IN THE EVENT OF ANY DISCIPLINE AND/OR ATTENDANCE ISSUES, EDWARDSBURG PUBLIC SCHOOLS RESERVES THE RIGHT NOT TO RENEW THIS AGREEMENT FOR THE SUBSEQUENT SCHOOL YEAR. MY SIGNATURE INDICATES ALL INFORMATION PROVIDED IS TRUE AND ACCURATE.  I AM AWARE IF INACCURATE OR FALSE INFORMATION IS SUBMITTED THAT IT MAY RESULT IN THE APPLICATION  BEING DENIED.  MY SIGNATURE ALSO INDICATES THAT I WILL ASSUME ALL FINANCIAL RESPONSIBILITY FOR MY STUDENT.
By entering your initials on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
The Board of Education does not discriminate on the basis of race, color, religion, national origin, sex, disability, age, height, weight, marital status, or any other legally protected characteristics, in its programs and activities, including employment opportunities. If any person believes that the Edwardsburg Public Schools District or any of the district’s staff has inadequately applied the principles and/or regulations of Title II, Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendment Act of 1972, Section 504 of the Rehabilitation Act of 1973, The Age Act and The Americans with Disabilities Act, s/he may bring forward a complaint to the district’s Civil Rights Coordinator, Edwardsburg Public Schools, 69410 Section St., Edwardsburg, Michigan 49112     (269-663-1048).
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