LAUREL SPRINGS SCHOOL DISTRICT

INTERDISTRICT PUBLIC SCHOOL CHOICE

NOTIFICATION OF INTENT TO PARTICIPATE IN THE

INTERDISTRICT PUBLIC SCHOOL CHOICE PROGRAM

for the

2012-2013 School Year

TO: The Superintendent/Chief School Administrator     DATE:________________

_______________________________________

Name of the district where you live

As Parent/Legal Guardian of the student named below, I am submitting this written notification of my child’s intention to participate in the Interdistrict Public School Choice Program (school choice program) in September 2012. I understand that you will notify me in writing no later than November 22, 2011 whether or not my child may participate in the school choice program.

RE: _____________________________________

Your child’s name

_________________________________________

Your child’s address

CURRENT SCHOOL:_______________________________

CURRENT GRADE: ______

SIGNED:_________________________________PRINT:_______________________

Signature of Parent or Guardian                        Name of Parent or Guardian

_________________________________

__________________________________

Address of Parent or Guardian

Due to district of residence by November 1, 2011

Admission for the 2012-2013 school year will depend

on the continuation of funding for the program.