in order to submit this request you must have access to an email:   Out of District instructions 

This request is for the following school year:        
Requested start date:
[please enter information as it appears on your child's birth certificate.]
Student Name:             Student ID #: 
Birth Date:      
City, State Zip
(i.e. Cumming, GA 30040):    

School/Grade student is currently enrolled at:    

School in which student is zoned to attend:   
School/Grade in which student is requesting to attend:     Grade:    
Type of Request:        
Parent/Guardian Name:     
Email Address: 
Home/Cell Phone:                       Work Phone: 
I agree that I am the parent/guardian of the child listed above on this confirmation of Out of District and that I have legal educational decision-making authority for the named student. I consent to provide an electronic signature for my student's Out of District request. I have provided my student's name and birthdate and confirm the accuracy of the information listed on the Out of District request form. I further agree, under penalty of law and per the Electronic Signature Act, that I am the person who is signing my name inside the electronic signature box and understand this electronic signature is considered equivalent to a signed or faxed signature.

    Type Full Name:   



Send Validation Code:     Select Provider:     


NOTE: If you do not receive a text, please check your email for the validation code.

If you have any issues with this form, please email:

Validation Code: