IPSWICH PUBLIC SCHOOLS

Office of the Superintendent

Ipswich, Massachusetts 01938

NONRESIDENT STUDENT APPLICATION

Applicant=s name:_______________________________________________________________

(First) (Middle) (Last)

Date of Birth: _______________________ Place of Birth: _____________________________

Gender: _____________ Last Grade Completed: _______ Current Grade: _________

Grade to which enrollment is requested: ______ Expected starting date __________________

Present school name and address: __________________________________________________

__________________________________________________

__________________________________________________

Present School Telephone: ( ) __________________________________________________

Names and ages of siblings under the age of twenty: ___________________________________

_____________________________________________________________________________

Home Address: _____________________________Home Telephone: ( ) ______________

_____________________________

Father=s Name: ___________________________ Daytime Phone: ( ) _________________

Mother=s Name: __________________________ Daytime Phone: ( ) _________________

Signature of Parent(s): ___________________________________ Date: __________________

___________________________________ Date: __________________

PLEASE RETURN THIS FORM TO:

Superintendent of Schools

One Lord Square

Ipswich, MA 01938

For Office Use Only:

Student’s LASID #: ____________________

Student’s SASID #: ____________________

Z:Forms/School Choice Application

Adopted: June 18, 1992