PRIMARY REASON FOR REQUEST: Check ONLY ONE …

Date: School Year: School District of Manatee County OFFICE OF STUDENT ASSIGNMENT. 1400 1st AVENUE E PALMETTO FL 34221. PHONE (941) 708-4971 FAX (941) 708-4976. HARDSHIP REQUEST FORM. SCHOOL BUS TRANSPORTATION WILL NOT BE PROVIDED. The Administrative Review Committee may consider statements submitted in support of the hardship request. Completing a hardship request form does not guarantee approval. School Wanting to Attend: Student Last Name: Student First Name: Date of Birth: Gender:_ Grade Level: Phone No. Current Address: Apt.#: City: State: Zip Code: Parent Email Address: Student Social Security #. (Section ). All new students to Manatee County must present a birth certificate and must answer both questions: 1. Is student of Hispanic, Latino or Spanish origin? Yes No 2. Race: ( Check all that apply). White Black or African American Asian American Indian or Alaskan Native Native Hawaiian or Pacific Islander Brother/Sister applying for hardship to same school: Name: DOB: Grade PRIMARY REASON FOR REQUEST: Check ONLY ONE REASON that applies Attachments Acceptable A.

Rev: 10/2017sac Date: School District of Manatee County . OFFICE OF STUDENT ASSIGNMENT 1400 1st AVENUE E PALMETTO FL 34221 School Year: PHONE (941) 708-4971 FAX (941) 708-4976

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