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School Governance and Facilities


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Name of Parent/Guardian__________________________________________


City/State__________________________________    Zip________________

Telephone Number - Home__________________   Work_________________

Name of Student__________________________________________________


City/State___________________________________________    Zip________

Telephone Number_______________________     Date of Birth_____________

Address Verification (Parent/Legal Guardian) (Attach copy of document)

____Rental contract

____Real Estate Contract signed by all parties

____Utilities Bill/Deposit Receipt

____Other, such as payroll check, driver's license, W-4, employment documents

Basis for Admission of Student (167.020 RSMo)

____Resides with parent in the school district

____Resides with legal guardian in the school district (Copy of court ordered guardianship must be attached.  A guardian may be appointed for the sole and specific purpose of school registration (SB944)).

____Resides with a military guardian in the school district (SB944).

____Homeless child (person less than 21 years of age who lacks a fixed, regular and adequate nighttime residence), including a child who is:

  1. ____living on the street, in a car, abandoned building or other form of    shelter not designated as a permanent home
  2. ____living in a community shelter facility
  3. ____living in transitional housing for less than one year

Give address or directions______________________________________

____Special circumstances (Section 167.151, RSMo):

  1. ____ an orphan
  2. ____ one parent living
  3. ____parents do not contribute to the student’s support
  4. ____agriculture (all four of the following conditions must be met: owns real estate of which 80 acres or more are used for agricultural purposes, parent's residence is on the real estate, at least 35% of the real estate is in the district, parent notified district on or before June 30 that student would be attending)

____Parent is a teacher under contract with the district (Board policy required-Section 167.151, RSMo, 168.151, RSMo)

____Parent is a regular employee with the district (Board policy required-Section 163.011, RSMo)

Other exemptions to the residency requirements (Section 167.020.6, RSMo)

____Attending school not in the pupil’s district of residence as a participant in an interdistrict transfer program established under a court-ordered desegregation program

____A ward of the state and has been placed in a residential care facility by state officials*

____Has been placed in a residential care facility due to a mental illness or developmental disability*

____Has been placed in a residential facility by a juvenile court*

____Has a disability identified under state eligibility criteria if the student is in the district for reason other than accessing the district’s educational program

*The district of residence will be billed for the local tax effort for the student(s) attending under these circumstances.

Date of Student Admission ______________________________________

____Student denied admission. Date of denial_______________________

____Waiver requested. Date of request____________________________


Waiver requested by:


b.____Legal guardian

c.____Student (at least 18 years old)

d.____Other _________________________________________________


Name of person/relative student resides with ____________________________________




Address Verification______________________________________

Reason why student is living with person/relative ___________________


____ Other reasons showing hardship or good cause_________________


Hearing Date (must be within 45 days of request)_______________________________________

____Student admitted pending decision on waiver request

Date student admitted_________________________________________

____Waiver granted. Date______________________________________

____Waiver denied. Date_______________________________________

Students attending school pursuant to the above information may be counted for state aid purposes.

Nonresident students who may enroll and are not counted by the district for state aid.


____Tax credit tuition-Any person who pays a school tax in any other district than that in which he resides may send his children to any public school in the district in which the tax is paid and receive as a credit on the amount charged for tuition the amount of the school tax paid to the district (Section 167.151(3), RSMo)

____Transportation Hardship as assigned by the commissioner of education (Section 167.121, RSMo)

____Attending a regional or cooperative alternative education program or an alternative education program on a contractual basis (Section 167.020.6, RSMo)

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