I wish to rescind the  Out of District Request for my child whose legal name is:

Student Last Name:   Application Number:  (Not Required)
Student First Name: Student ID:
Student Date of Birth:
Currently Attending: *

The form is to Rescind the Out of District Request for:

Name of School Rescinding:
Name of School your child is districted to attend:
Student to Start:

I understand that my child's previously approved Out of District Request will not be considered and I must submit a new Out of District Request if I change my mind:

Parent/Guardian Legal Name:
Full Time Address:
City/State/Zip Code:
Email Address:

I agree that I am the parent/guardian of the child listed above on this confirmation of Rescinding my application for an 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 Rescind Request. I have provided my student's name and birthdate and confirm the accuracy of the information listed on this Out of District Rescind 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 your name: