Use this form to request your student attend a school in ONE91 other than your school of residence. If approved, parent/guardian is
responsible for transportation. A decision will be communicated after the lottery process is held on the 5
th
of the month. The
variance process can be viewed on the district website at www.isd191.org.
Variance requests do NOT need to be completed annually; only when the student’s address or school changes (e.g. elementary to middle
school).
Submit one form per student to:
ONE91 Enrollment Center, 200 West
Burnsville Parkway, Burnsville, MN 55337, E-mail to enrollmentcenter@isd191.org or Fax to
952-707-4181.
Student Information:
Name (Last, First, Middle)
Current Grade: Requested Grade: Date of Birth:
Parent/Guardian Information:
Name (Last, First, Middle)
Address (Street, City, Zip)
Telephone Number(s)
E-mail Address
School of Residence School Requested Requested Start Date
Reason for request:
☐ To remain at the school my student is currently attending.
☐ Student has a sibling who currently attends the requested school.
☐ Student has a parent who works at the requested school.
☐ Student has child care in the neighborhood of the requested school.
☐ Other:
Parent/Guardian Signature Date
2022-2023 School Year
For Office Use Only: Student ID #
Approved Denied
Authorized Signature Date
Comments
Distribution: School of Residence & Variance School
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
