Vandercook Lake School of Choice Applicant Information:

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Notification will be made by school district to the parent/guardian. This form is only required if you live outside of Vandercook Lake District.
Note: A meeting may need to take place with Principal before decision is made. Thank you.

Email *

Student Name *

Student Grade (entering) *

Student Date of Birth: *

Last School Attended: *

District of Residence: *

Were there other siblings or household members attending Vandercook Lake Schools during the previous school year? *

Yes

Please Check: *

Male

Female

Parent Information: Please list Parent Name & Address
*

Parent Information: Phone Number
*

Has the applicant(student) been expelled or suspended from school within the last 2 years? *

Yes

If yes, please explain suspension.

Does the applicant require special education services? *

Yes

If yes, please identify program:

Records, including discipline and attendance, may be requested from your previous school. Do you give permission for the applicant's records to be released? *

Yes

Parent/Guardian Electronic Signature. *

Applications for admission as non-resident students and their parents/guardians are hereby notified that Vandercook Public Schools does not discriminate on the basis of race, color, national origin, sex, religion, or disability in admission or access to programs or disability in admission or access to, activities or policies. Any person having inquiries concerning the district's compliance with the regulations implementing Title VI, Title IX or Section 504 of the Rehabilitations Act, is directed to contact the district superintendent.

_________________________________________________________________________________________________
For Office Use:

_____ Approved _____Not Approved

Authorized Signature________________________________________________Date_________________

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