Open Enrollment Application

Student Name*
First Last
What grade is your student applying to attend in the 2022-23 school year?*
This is the grade your student is applying to attend at Churchill for the 2022-2023 school year.
Student #
Leave blank if unknown.
Legal Address*
Street Address City State ZIP Code
Phone*
Birth Date*
MM
DD
YYYY
Boundary School*
If other, please specify school and district
Current School*
If other, please specify school and district
Requested School*
Reason for Request*
Has the student ever been suspended or expelled from a public school?*
If yes, please explain.
Does your student require services or programs other than what is offered in the regular school classroom?*
If yes, please explain.
Does your student have a sibling already attending Churchill Jr?
Sibling Name:
First Last
I understand that all transfer requests are contingent on early enrollment school capacity ("maximum capacity") or late enrollment school capacity ("adjusted capacity"), special program limitations, staff availability, and/or circumstances under 53A-2-207(4)(c). If this request is granted, I agree that my child must remain at the requested school through the end of the requested school year. I understand that I, as parent or guardian, am responsible for transportation of my student to and from school. I understand that a students' acceptance into a school or school district does not establish UHSAA eligibility. Type your name to signify you agree.*
Home Phone*
Work Phone
Email*

Please ensure that you verify the accuracy of this email, as all notifications will be sent to this address.

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