McComb Local School                                            Interdistrict Open Enrollment Application
Application for Open Enrollment for the 2023-2024 School Year
**Please submit one response per child**
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Student First Name *
Student Middle Name
Student Last Name *
Student Date of Birth *
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Parent/Guardian Full Name *
Street Address *
City, State, Zip *
County of Residence *
Phone Number *
Parent/Guardian Email Address *
2023-2024 Grade Level *
Gender *
School District of Residence *
Current School Attending *
Are you currently under a suspension or expulsion for 10 consecutive days or more? *
Have you been suspended or expelled in either the current or preceding semester? *
Does your educational program include an individualize education plan (IEP) or 504 plan? *
If yes, what type of program?
I understand that I need to apply each year for open enrollment.  I understand transportation is not provided with this program and that it is my responsibility to transport my child.  I understand that all prior year school fees must be paid for my application to be reviewed by administration. *
Parent/Guardian Signature *
Submit
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