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Application for Admission of Non-Resident Student

Please complete the following Student and School information on the form below. Required fields marked with an asterisk *. If you have any questions please contact the school your child will be attending.

Bennett Elementary School 303-644-3234 x1000

Bennett Intermediate School 303-644-3234 x2200

Bennett Middle School 303-644-3234 x5000

Bennett High School 303-644-3234 x7000

STUDENT INFORMATION

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Current Grade Level*

Answer Required

Mailing Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Physical Address (if different from Mailing Address)

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Parent/Gaurdian Contact Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email 1*

Answer Required

Email 2

Answer Required

Primary Phone*

Number Required

Secondary Phone

Number Required

CURRENT SCHOOL INFORMATION

Current School Name*

Answer Required

Dates from/to (month & year)*

Answer Required

Mailing Address of School

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Phone Number*

Number Required

Name of Principal*

Answer Required

PREVIOUS SCHOOL INFORMATION

Name of Previous School (if applicable)

Answer Required

Dates From/To (month & year)

Answer Required

Address of Previous School

Mailing Address of School

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Phone Number

Number Required

Name of Principal

Answer Required

ATTENDANCE/DISCIPLINE INFORMATION

The following questions pertain to the student listed above.

Is this student currently suspended or expelled from any public or private school?*

Answer Required

Yes

How many school days has this student missed in the past 12 months?*

Answer Required

How many were excused absences?*

Answer Required

How many were unexcused absences?*

Answer Required

EXTRA-CURRICULAR ACTIVITIES

Please list any extra-curricular activities in which this student participates in.

Answer Required

Is there any additional information or explanations that you would like to supply?

Answer Required

Please explain why you wish to have your student attend Bennett School District 29J?*

Answer Required

FOR OFFICE USE ONLY

Notes from Adminstrator:

Approval of non-resident student enrollment

Answer Required

Yes

Signature of Administrator____________________________________________ Date_____________________