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Early childhood /special education

Wisconsin Department of Public Instruction INSTRUCTIONS: Submit completed form to the district administrator PUBLIC school OPEN enrollment of the nonresident school district. Do not send this form to the ALTERNATIVE OPEN enrollment Department of Public Instruction. APPLICATION PI-9421 (Rev. 06-2021) Additional instructions and information are at the end of this form. school Year for which Open Date Received in Nonresident enrollment Exception is Requested school District Collection of this data is a requirement of s. , Wisconsin Statutes. 2021-22. I. GENERAL INFORMATION. To be completed by the parent or legal guardian (or the pupil if age 18 or older). The form must be submitted to the nonresident school district with any required documentation (see back of form). Legal Name of Pupil First, Middle Initial, Last (A separate form must be completed for each pupil) Gender Birthdate M F.

What school district, private school, or homebased education program is the pupil currently attending?- ... An exception to the open enrollment application period is in the best interest of the pupil. Provide an explanation, in Section III, of the circumstances leading to this request.

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