OPEN ENROLLMENT APPLICATION
USE A SEPARATE FORM FOR EACH STUDENT
Amphitheater Public Schools Open Enrollment Application form is for families who live inside or outside the district
and are requesting to attend a school other than the school assigned to the area where they live.
*Required Fields
School Year for Open Enrollment:
*School Desired 1st Choice School Desired 2nd Choice School Desired 3rd Choice
*School Choice *School Choice *School Choice
Student Information
*First Name: *Last Name:
*Date of Birth: *Gender:
*District of Residence: *Current Grade:
*Neighborhood School: *Continuing or New Amphi Student:
*Current School Attending: *From: To: (Leave blank if still attending)

Does the student have siblings currently enrolled in an Amphitheater school or applying for open enrollment at an Amphitheater school?
Sibling Name Amphitheater School Current Grade Continuing or New

Student Home Address
*Street Address
*City: *State:
*Postal/Zip Code:
Is Mailing Address different than above?
*Street Address
*City: *State:
*Postal/Zip Code:
Parent/Guardian Information
Primary Contact
*First Name: *Last Name:
*Email Address:
*Primary Contact Phone Number Secondary Contact Phone Number
Is Primary Contact Address different than student's?
*Street Address
*City: *State:
*Postal/Zip Code:
Secondary Contact
First Name: Last Name:
Primary Contact Phone Number Secondary Contact Phone Number
Is Secondary Contact Address different than student's?
*Street Address
*City: *State:
*Postal/Zip Code:

*Are either parent/guardian an employee of Amphitheater School District?  

Programs/Services Information

Has the student received in the past, or may be in need of the following services? (Check all that apply)





*First Language:

*Does the student have any health issues that might require special health services by the school?  


*Is there any reason that the student may require an accommodation or evaluation for special assistance?  


*Is the student currently suspended or expelled?  


*Is disciplinary action pending at student's current school?  


*Has the Juvenile Court imposed any conditions upon the student?  

Parent/Guardian Agreement
Please read these statements carefully and check the box to indicate your agreement.

Transportation of open enrollment students is the parent/guardian’s responsibility. Transportation is provided to school(s) without established boundaries. Once accepted for transfer, open enrollment students are not required to apply for open enrollment status each school year, unless the student has disciplinary or attendance problems.
 
If my child is accepted for enrollment in Amphitheater Public Schools, I agree to abide by all District policies and regulations as delineated in the Student Handbook and District Policy Manual. I also understand that serious, or repeated instance of misconduct by my child may result in revocation of open enrollment status.
 
I authorize the release of educational records from the prior school listed on this Open Enrollment Application to Amphitheater Public School District.
 
I affirm the information I provided on this application is accurate.
 

A.R.S. §13-2407 provides that any submission of a false registration form to any government office constitutes a class 6 felony and will constitute grounds for student withdrawal from this district.

Please review your application form carefully before submitting.

An email Confirmation will be sent to you with a copy of your submitted application.

Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital status, political beliefs/affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquiries regarding the District’s non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw, Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com