Receiving School / INFORMATION RELATIVE TO APPLICATION FOR STUDENT ATTENDANCE IN OUT-OF-STATE PUBLIC OR PRIVATE SCHOOL FOR SPECIAL EDUCATION Under Section / School District of Residence / exceeding school district / Telephone Number Special Education Unit / Enclosure PRIVATE SCHOOL / Private School / Applying School District of Residence Address / Special Education Unit / Department of Public Instruction / resident school district / DEPARTMENT OF PUBLIC INSTRUCTION OFFICE OF SPECIAL EDUCATION RETAIN ONE COPY FOR YOUR FILES SFN / Board of Public School / Applying School District of Residence / Address Administrator’s Telephone Number If receiving school district / / /
Position
Clerk / Director of Special Education / teacher / superintendent of public instruction / school district superintendent / State Superintendent of Public Instruction SFN / Administrator School Date SUPERINTENDENT OF PUBLIC INSTRUCTION APPROVAL / Administrator Administrator / President / Superintendent / State Director / administrator / /
Microsoft Word[removed]Memo.doc