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LINCOLN CONSOLIDATED SCHOOLS Ypsilanti, Michigan SCHOOL OF CHOICE APPLICATION PROCESS 2012‐2013 SECOND SEMESTER APPLICATION PERIOD—JANUARY 7‐17, 2013 Kindergarten 1) Complete a School of Choice Application for each student in your household. Submit to the Superintendent of Schools in person, by fax (484‐7014), or by mail no later than January 17, 2013. 2) You will be notified when the application is approved. 3) You may enroll your student once the application is approved. Second semester enrollment MUST be finalized by Friday, January 25, 2013. Grades 1‐12 1) Complete a School of Choice Application, Affirmation of Prior Discipline Record, and Request for Student Discipline Records for each student in your household. Submit to the Superintendent of Schools in person, by fax (484‐7014) or by mail no later than January 17, 2013. 2) Once we receive your completed application materials, we will fax the Request for Student Discipline Records to the schools the student attended during the prior two years. 3) The Superintendent will review the student’s discipline records upon receipt from the prior school and will either approve or deny the application. This could take some time, as there is often a delay in receiving discipline records. Applications will not be considered until discipline records are received and reviewed. 4) You will be notified when your application is approved or denied. Denial would be based on past discipline only. 5) You may enroll your student once the application is approved. Second semester enrollment MUST be finalized by Friday, January 25, 2013 . Central Enrollment Office Brick Elementary School—Administration Office (West Entrance) 8970 Whittaker Road Ypsilanti, MI 48197 Phone: (734) 484‐7042 Fax: (734) 484‐1212
Lincoln Consolidated Schools 2012-2013 Second Semester School of Choice Application Applications Accepted January 7, 2013 through January 17, 2013The Lincoln Consolidated Schools Board of Education has opened its doors to all students residing in Washtenaw Countyand all contiguous counties. Completed application forms and requested documentation must be returned to theSuperintendents Office by January 17, 2013. A separate application form must be completed for each student desiringto attend the Lincoln Consolidated Schools under the Schools of Choice State Aid Act of 1996, P.A. 300, Sections 105and 105c.Student Name: Student Date of Birth: Last First InitialPermanent Address for Student: Number Street City State ZipMailing Address (if different): Number Street _________________________________________________________________________________________ City State ZipHome/Cell Phone: Current Grade: Note for high school: Credit requirements forDistrict in which you reside: grade level must meet LCS policies.How did you hear about Lincolns school of choice option?Parent/Legal Guardian Name: Work Phone: Last FirstParent/Legal Guardian Name: Work Phone: Last FirstList previous schools attended with current/most recent first (attach an additional sheet if necessary):School District City, State Dates Attended Reason for LeavingPlease complete the following:1. Has the student ever been expelled from another school? If yes, please explain: Yes No2. Has the student been suspended from another school during the preceding two (2) Yes Noschool years? If yes, please explain:3. Has the student been truant or had attendance problems at another school during Yes Nothe preceding two (2) years? If yes, please explain:
4. It is understood that the student may be athletically ineligible for one (1) full semester according Yes Noto M.H.S.A.A. rules.5. Was the applicant previously enrolled in Lincoln Consolidated Schools? If yes, when? Yes No6. Has the applicant received special education service (s) at any time? If so, please list Yes Noservice(s) and attach IEP form:7. It is understood that transportation may be provided if the student is dropped off and picked up Yes Noat a designated Lincoln bus stop. Students must be pre-registered for this service. School of choicestudent transportation depends on seating availability.8. It is understood that the student will adhere to the attendance policies that are written Yes Noin the student handbooks and that tardies/absences will not be excused because of lackof transportation or weather conditions. As the parent(s)/legal guardian making application for Schools of Choice under State Aid Act of 1996, P.A. 300, Sections 105 and 105c, my/our signature(s) on this application signifies my/our understanding and agreement to the Schools of Choice language and guidelines and to all rules and regulations of student handbooks. It is also understood that if Lincoln Consolidated Schools finds any information that is incorrect or falsified on this application, including affirmation of prior discipline records, this would immediately terminate enrollment of the student on this form. My/Our signature(s) holds harmless the Lincoln Consolidated Schools, their employees, and Board of Education members for any decisions made relative to the Schools of Choice language and guidelines. It also grants Lincoln Consolidated Schools permission to contact our current district to obtain school records for my/our student, including discipline records. NOTE: Lincoln Consolidated Schools will accept non-resident students without regard to intellect, academic, artistic, athletic, or other ability or talent, mental or physical disability, religion, race, color, national origin, sex, height, weight, or martial status. Lincoln Consolidated Schools reserves the right to deny access to a student residing outside the Washtenaw Intermediate School District if mutual agreement can not be reached with the students home district/ISD related to responsibility for added costs. Parent /Guardian Signature Date Parent /Guardian Signature Date The following items must be submitted in order to complete Please return this application & requested documents to: your application. Mrs. Ellen Bonter, Superintendent School of Choice Application Lincoln Consolidated Schools 8970 Whittaker Road Affirmation of Prior Discipline Record (Grades 1-12 only) Ypsilanti, MI 48197 Request/Release for Student Discipline Records For questions or additional information please call the (Grades 1-12 only) Superintendent’s Office at (734) 484-7001. IEP (if applicable) Report Card (Grades 1-8) or Transcripts (Grades 9-12) (Office Use Only) Application Received: Discipline Release Faxed: Request is: Granted Denied By: ______________________________ Date: Date notification sent to/picked up by Parent(s)/Legal Guardian: Date request for student records sent: Name of School: _____________ _____
Lincoln Consolidated Schools 8970 Whittaker Road Ypsilanti, MI 48197 Phone: (734) 484-7001 / Fax: (734) 484-7014 REQUEST FOR STUDENT DISCIPLINE RECORDS (Grades 1-12 only)Date: ____/____/____Student Name:Name of Former SchoolStreet AddressCity/State/ZipTelephone/FaxThe above-named student has applied to attend Lincoln Consolidated Schools under the schools ofchoice program. Please fax the student’s discipline file for the 2010-11, 2011-12, and 2012-13 (firstsemester) school years. If there is no discipline on file, please indicate on the bottom of this form and faxit back to us.Final acceptance is contingent upon further review of the student’s discipline file and thus, ONLYdiscipline information is needed at this time. If accepted as a school of choice student, additionalrecords will be requested under separate cover. Thank you in advance for your assistance. PARENTAL PERMISSIONI hereby authorize the release of all discipline records for the above student to Lincoln ConsolidatedSchools. _____/_____/_____ Signature of Parent/Guardian Date************************************************************************************************************************____________________________ has no discipline infractions for the 2010-11, 2011-12, and 2012-13 (Student Name) (first semester) school years. ________________________________/____________ Name Date _____________________________________________ Title _____________________________________________ School District
Lincoln Consolidated Schools 8970 Whittaker Road Ypsilanti, MI 48197 Phone: (734) 484-7001 / Fax: (734) 484-7014 Affirmation of Prior Discipline Record (Grades 1-12 only)Student Name:Previous School District:Building:Address:Directions:Please check paragraph 1 or 2, provide all appropriate information, and sign/date.A willful false statement on this affirmation will result in a report to the appropriate authorities andpossible removal from the Lincoln Consolidated Schools District. Paragraph 1: The undersigned affirms that the student has not been suspended or expelledfrom any public or private school in Michigan or any other state, for an offense involving weapons,alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence againstpersons and/or property committed on school premises, at any school-sponsored activity, or on apublic or private conveyance providing transportation to and from a school or school-sponsoredactivity. Paragraph 2: The undersigned affirms that the student has been suspended or expelled fromany public or private school in Michigan or any other state, for an offense involving weapons, alcoholor drugs, or for the willful infliction of injury to another person or for any act of violence againstpersons and/or property committed on school premises, at any school-sponsored activity, or on apublic or private conveyance providing transportation to and from a school or school-sponsoredactivity.If you checked paragraph 2, explain the incident in detail on a separate sheet of paper.Parent /Guardian Signature Date