Portal

Request for Open Enrollment

ITHACA CITY SCHOOL DISTRICT

400 Lake Street • P.O. Box 549 • Ithaca, New York • 14851-0549

School Year:*

Middle School Elementary School

INSTRUCTIONS: Students must be residents of the Ithaca City School District and registered in their Home School in order to be considered for Open Enrollment. A new application is required if a request is being made for a new, non-Home School placement. Once applications have been approved, students are not required to reapply*. Open Enrollment into a particular school is dependent upon space availability and staffing.

The parent/caregiver is to complete all information on this form no later than 1st Friday in June. In the absence of extenuating circumstances, late applications will not be processed.

Written notifications will begin in mid-June, but could be made as late as the end of August.

STUDENT INFORMATION

Last Name:*

First Name:*

Middle Initial:

Date of Birth:*

Entering Grade:*

in September 20

ADDRESS and CONTACT INFORMATION

Name(s) of Parent(s)/Caregiver(s):

Address:

Street(Apt and/or building #)

City

ST

Zip

Home Phone:

Cell Phone:

Work Phone:

Email Address:

OPEN ENROLLMENT REQUEST

ICSD Home School:*

Requested School:*

Choice #1:*

Choice #2:

Choice #3:

Boynton Middle School DeWitt Middle School

Please note that Lehman Alternative Community School is not considered in the Open Enrollment process

Reason for Request:*

ACKNOWLEDGEMENT

*I understand that, unless otherwise indicated, if this Open Enrollment request is granted: 1) transportation is not provided by Ithaca City School District and I hereby agree, by signing below, to waive ICSD transportation for my child to and from the school outside my child’s designated attendance zone for the entirety of the Open Enrollment period; and 2) the Ithaca City School District reserves the right to rescind Open Enrollment due to space availability, staffing, attendance issues, and other considerations

Signature of Parent/Caregiver (use mouse)

Date

ICSD ACTION - Adminstration Use Only

Residency & registration verification completed on

Approved Denied

ICSD Decision:

Comments:

Signature of ICSD Administration

Date:

Print Break

Student ID: