Date: _______ School Year: _______
Rev: 2017 sac
School District of Manatee County
OFFICE OF STUDENT ASSIGNMENT
1400 1
st
AVENUE E PALMETTO FL 34221
PHONE (941) 708-4971 FAX (941) 708-4976
STUDENTASSIGNMENT@MANATEESCHOOLS.NET
RESCIND CHOICE/HARDSHIP REQUEST FORM
School Wanting to Rescind: __________________________________________________________________________
(The school you DO NOT want your child to attend)
Reason: __________________________________________________________________________________________
Student Last Name: __________________________________Student First Name: _____________________________
Date of Birth: ___________________Grade Level: _______Phone No.:________________________________________
Student Last Name: ______________________Student First Name: _________________________________________
Date of Birth: ________________________Grade Level: _______Phone No.:___________________________________
Student Last Name: __________________________________Student First Name: _____________________________
Date of Birth: ________________________Grade Level: _______Phone No.:___________________________________
Current Address: ________________________________________________________Apt.#: ______________________
City: _________________________________________State:________________Zip Code: _______________________
My signature below acknowledges that I am requesting my child/ren’s approved School Choice and/or Hardship be
rescinded. Should I wish for my child to attend a school other than his/her zoned school, I realize that I must reapply
for School Choice/Hardship. I also understand that in most cases, only one School Choice/Hardship is granted per
academic year.
__________________________________________________________
Enrolling Parent/Guardian Signature
Parent First Name: ____________________ _ Parent Last Name: __________ _______________________
For office use:
Approved/Denied:__________________ Zone: ________________________ Letter Sent: ___________ E:_____ T:____
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