The Amherst Schools
550 Milan Ave, Amherst, Ohio 44001
(440) 988-4406
INTERDISTRICT OPEN ENROLLMENT APPLICATION
2022-2023 RELEASE OF SCHOOL RECORDS AUTHORIZATION
Please Print All Information Date________________
Name of Student: _________________________________________________ Birthdate _________________________________
(Student must be five years of age by August 1
st
to enroll in kindergarten)
Se
x ________ Ethnicity ___________ Current Grade __________ Grade Next Year __________ JVS __________________
School District of Residence ___________________________________ Last School Attended ____________________________
Contact Person at Previous School_________________________________ Phone Number of Previous School _________________
Parent/Guardian Name: __________________________________________________ Home Phone: _________________________
Address: ______________________________________________________________ Work Phone: _________________________
Is student enrolled in a special education or tutorial program? Yes ________ No ________
If yes, does your child receive services for - Speech: Yes _______ No ______ , Occupational Therapy: Yes ______ No ______,
Phys
ical Therapy: Yes ______ No ______, Special Transportation: Yes ______ No ______
If enrolling for high school, list special courses/classes desired:
_______
_________________________ __________________________________ _____________________________________
RELEASE OF RECORDS AND INFORMATION AUTHORIZATION IS GRANTED TO AMHERST SCHOOLS FOR THE
STUDENT LISTED ABOVE WITH THE FOLLOWING SIGNATURE ON THIS APPLICATION:
Pa
rent/Guardian Signature ____________________________________________________ Date __________________________
Inaccurate or incomplete information provided
may disqualify the application for approval
One application must be filed for each student.
If you are accepted in the Amherst Schools and plan to use our district transportation, please contact the Transportation
Supervisor at 440-988-2633 for possible options regarding transportation for your student(s). The supervisor will be able to
instruct you to the appropriate bus stop and transportation policies for your child/children.
STUDENTS WILL BE APPROVED FOR ONE SCHOOL YEAR ONLY AND MUST REAPPLY
ANNUALLY FOR REVIEW AND APPROVAL
(For Office Use Only)
Re
ceived by: ______________________________________ Date: _____________________ Time: ______________________
Approved by: ______________________________________________________________________________________________
A typed signature replaces a ha
ndwritten signature and is legally binding.
