BSSD Application for Admission - Out of District Status

BSSD Application for Admission

Out of District Status

Bradford Special School District 106 W. Front St. PO Box 220 Bradford, TN 38316

Application requested by 3:00 p.m. July 1st


Please complete a separate form for each student requesting Out of District Status in Bradford Schools.


Student’s Name DOB Age SSN



School Requested Grade to be Enrolled Last School Attended


District in which students presently resides:

Legal Custodial Parent’s/Guardian’s Name:

Address:

Mailing Address (if different):

City: County: State: Zip:

Contact: Home Phone Cell Phone Work Phone

Check below the reason(s) the transfer is being requested:

Bradford Special School District Employee Special Course/Program Request
Reside on border road
Majority to Minority
Joint Custody Name of Sibling(s):
Reside outside of Gibson County Grade
Other
Grade

Grade

Reason for Requesting Transfer:








BSSD Application for Admission Out of District Status, continued


Student’s Name

Please answer each of the following questions:

Has this student ever had disciplinary problems at school? Yes No (If yes, check disciplinary measures taken:

Suspended Expelled Alternative School Other Please explain:



Has this student ever had attendance problems at school? Yes No (If yes, please explain:



Has this student ever had problem with being tardy to school? Yes No (If yes, please explain:



Has this student ever been referred by a previously stated school to the truancy board or juvenile court
for attendance or disciplinary purposes? Yes No (If yes, please explain:





Parental Acknowledgment:

I have read BSSD policies 6.204, Attendance of Non-Resident Students, and agree to the terms as stipulated. I
understand that Out of District Students are accepted only if current enrollment permits. Any
parent/guardian/student who falsifies any information required by this document shall not be permitted to enroll
in Bradford Special School District.

A pupil can have only one legal residence and that legal residence will be deemed to be the same as the legal
residence of the pupil’s custodial parent(s), legal custodian (court appointed or approved) or legal guardian
(court appointed or approved). The legal residence of the pupil’s custodial parent(s), legal custodian or legal
guardian is the location where the custodial parent(s), legal custodian or legal guardian continuously lives with
the intention of remaining. This is an annual contract. Renewal will be required each school year.



Signature of Parent/Guardian Date

*If student was not enrolled in BSSD this past school year, please attach each of the following documents:

Copy of Grades or Report Card from the previous school year

Copy of Discipline Record from the Previous School Year

Copy of Record of Attendance from the Previous School Year


* Note: Application will NOT be considered complete without the attachments of these three items.