Fillable FORM CHP 13-1: GEOGRAPHIC EXCEPTION REQUEST (Hawaii DOE)

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FORM CHP 13-1: GEOGRAPHIC EXCEPTION REQUEST (Hawaii DOE)

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  • 13 check-boxes
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STATE OF HAWAII
DEPARTMENT OF EDUCATION
P.O. BOX 2360
HONOLULU, HAWAII 96804
THE GEOGRAPHIC EXCEPTION FORM DOES NOT APPLY TO HOMELESS STUDENTS UNLESS
the request is for a student to attend a school other than the school of origin or home school
.
SECTION I – To be completed by parent/legal guardian of student and submitted to the Home School if the
student is new to the D.O.E. or to the current school where the student is currently enrolled. Submit to the
Principal with a self-addressed, stamped envelope attached to each Geographic Exception Request Form.
Requesting Geographic Exception to Attend: For School Year -
Name of School For Grade Level
1. Student’sLegalName
Last First Middle Initial
2. Birth Date / / Gender
q
Male
q
Female
mm / dd / yy
3. Current School Current Grade Level
4. Residential Address
City State Zip Code
5. Requester’sName
Address
City State Zip Code
Phone: (H) (Bus) (Cell)
Email
q
Parent
q
Guardian
q
18-year-old student
6. IndicatereasonforrequestingaGeographicException(Check1itemand/orbrieyexplain)
a.
q
Physical residence b.
q
Sibling at same school c.
q
Child of school staff member
d.
q
Program of study (describe)
e.
q
Other (describe)
Iunderstandthatfalsicationofinformationwillbegroundsfordenialand/orrescindingofthisGeographicException
Request(HawaiiRevisedStatutes(HRS)§710-1063).
Signature Date / /
SECTION II – To be completed by the public school the child is currently attending OR the Home School for the
incoming kindergarten and new students to the HIDOE system.
School Date Stamp Receipt of Application
q
Proof of Residence Document Reviewed
List of information regarding special student accommodations (if applicable)
Home/CurrentSchoolAuthorizedOfcialSignature Date / /
SECTION III – To be completed by the Receiving School Lottery Number
q
APPROVED G.E. - To begin on: / / School Name
mm / dd / yy
q
DENIED G.E. - Filled to capacity
ReceivingSchoolAuthorizedOfcialSignature Date / /
RequestforReviewofDenialmaybemadewithinten(10)businessdaysofthepostmarkdateofthisnoticetothe
ComplexAreaSuperintendent(CAS)bysubmittingFormCHP13-2.ThedecisionmadebytheCASisnal.
DISTRIBUTION: WHITE-(Approved) or (Denied)-Receiving School; CANARY-Requester; PINK-Receiving School Complex Area Superintendent;
GOLDENROD-Home School Principal
If Form was downloaded from Website: Colored paper is NOT required for DISTRIBUTION copies.
GEOGRAPHIC EXCEPTION REQUEST
FORM CHP 13-1
(Revised December 2014)
FOR SCHOOL USE ONLY
Student ID# (10 Digits)
Home School Code
Current School Code
Receiving School Code
Date of Approval or Denial
/ /
mm / dd / yy
FORMCHP13-1,Rev.12/14,RS15-0623(Rev.ofRS13-0857)
mm /
dd
/ yy
mm / dd / yy
mm /
dd
/ yy
CHP13_1_RevDec2014_150623.indd1 12/1/1410:08AM
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THE GEOGRAPHIC EXCEPTION FORM DOES NOT APPLY TO HOMELESS STUDENTS UNLESS
the request is for a student to attend a school other than the school of origin or home school.
GENERAL INSTRUCTIONS FOR COMPLETION OF THE GEOGRAPHIC
EXCEPTION REQUEST FORM CHP 13-1 (Rev. December 2014)
GeographicException(G.E.)RequestFormsmaybeobtainedfromanyHawaiiDepartmentofEducation
(HIDOE)publicschoolofce,includingpubliccharterschools.
Parents/LegalGuardiansandstudentswhoareeighteen(18)yearsofageshouldsubmitG.E.RequestFormsto
theHomeSchoolorCurrentSchoolPrincipal/Ofce.
DEADLINE:
TheapplicationwindowforsubmittingG.E.RequestFormsisfromJanuary1
st
through March 1
st
of a calendar
yearfortheupcomingnewschoolyear.Whenschoolsreceivemoreapplicationsthanavailablespace,alottery
willbeconductedontherstFridayofAprilofthatsamecalendaryear.Allcompletedrequestformsthatdonot
meetthisdeadlinewillnotbepartofthelotteryandmaybeconsideredafterthoseapplicationsthatwerereceived
withintheestablishedtimeperiod.
GENERAL INFORMATION:
• IfyourchildisenrolledintheHawaiiPublicSchoolSystem,submitthisformtothepublicschoolyourchildis
currently attending.
• IfapplyingforKindergarten,submitthisformtotheHomeSchoolwhereyourchildwouldattendatthe
start of the next school year.
• Applications submitted during the summer for students promoted to middle or high school should be
turnedintotheHomeSchoolyourchildwouldattendatthestartoftheschoolyear.
• If your child is entering from a private, mainland, or foreign school, submit the form to the Home School for the
schoolyeartowhichthisformapplies.
• Requestforreviewofdenialmaybemadewithinten(10)businessdaysofthepostmarkdateofthe
noticetotheComplexAreaSuperintendent(CAS)bysubmittingFormCHP13-2,whichisavailablefromany
publicschooland/ordistrictofce.AwrittenlettertotheCAScanalsobesubmitted.ThedecisionbytheCAS
isnal.
Please attach a self-addressed, stamped envelope for each G.E. Request Form. The results of the lottery
(approvalordenial)willbemailedwithintwoweeksthereafter.
Falsicationofinformationwillbegroundsfordenialand/orrescindingofthegeographicexception.
(HRS§710-1063).
TERMINOLOGY:
• Home School: The public school (including public charter conversion schools) that the student should be
attendingwithoutaGeographicException,accordingtolegalresidence.
• CurrentSchool:Thepublicschool(includingpubliccharterorpubliccharterconversionschools)wherethe
student is presently attending.
• Receiving School: The school that determines the acceptance or denial of the application.
Titleis60%ScreenandBodycopyis35%.
CHP13_1_RevDec2014_150623.indd2 12/1/1410:08AM
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FORM CHP 13-1: GEOGRAPHIC EXCEPTION REQUEST (Hawaii DOE)

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Completed 15 January 2021

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