Fillable PA28+ Tuition+ Contract (City of Oakland)

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PA28+ Tuition+ Contract (City of Oakland)

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File type: PDF

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Revised 11/6/2017
PRINCE GEORGE’S COUNTY PUBLIC SCHOOLS
DEPARTMENT
OF
PUPIL ACCOUNTING
APPLICATION FOR REQUEST TO ENROLL NONRESIDENT
STUDENT
(STUDENT PLACED BY A STATE OF MARYLAND APPROVED AGENCY)
Name of Student: School: Grade: DOB
Is this student in a Special Education Program?
Yes ☐ No ☐
Intensity Level Residential:
Yes ☐ No ☐
Name of Biological Mother
Last Known Address:
Street City/County Zip
Name of Biological Father
Last Known Address:
Street City/County Zip
Parental Rights Terminated?
Yes ☐ No ☐
Agency with Order of Care:
Address of Agency:
Street
City/County
Zip
Name
Telephone
E-mail
FAX
Contractual Service Provider:
Address:
Street
City/County
Zip
Name
Telephone
E-mail
FAX
Signature of Social Worker:
Placing Agency
Date
FOSTER FAMILY/GROUP HOME
Name:
Address:
Street
City/County
Zip
Contact:
Work Phone
Cell Phone
FAX
Questions relating to the processing of this form should be referred to the Department of Pupil Accounting. (301) 780-6864
EMAIL COMPLETED TUITION CONTRACT TO: pasb.fostercare@pgcps.org or FAX to (301) 952-6784
TUITION CONTRACT MUST BE RENEWED EACH ACADEMIC SCHOOL YEAR
STUDENT ID:
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PA28+ Tuition+ Contract (City of Oakland)

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Completed 18 July 2020

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