School Year*field type drop-down
Forms 10s will be considered in the lottery if turned in by 4:00pm on 1/17/25
Permission to attend a school other than the school of residence must be on written request of the parent or guardian (and must be considered prior to the student's enrollment). A request must also be made when a student moves out of a school's attendance area but wishes to remain in the school in which he/she is enrolled.
We will contact you by phone/mail once we can approve your request.
Parent/Guardian*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email*field type email
Home Address*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
City*field type drop-down
Zip Code*field type number
Preferred Phone #*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

	Student Name*field type single line	Birthdate*field type single line	Grade*field type drop-down	IEP*field type drop-down
row 1	Student Name*field type single line Input blocked. Maximum character limit of 256 characters reached.	Birthdate*field type single line Input blocked. Maximum character limit of 10 characters reached.	Grade*field type drop-down	IEP*field type drop-down

	Last School Attendedfield type single line	School of Residencefield type drop-down	Perm ID(?)field type number
row 1	Last School Attendedfield type single line Input blocked. Maximum character limit of 4000 characters reached.	School of Residencefield type drop-down	Perm ID(?)field type number

	1st School of Choice*field type drop-down	2nd School of Choicefield type drop-down
row 1	1st School of Choice*field type drop-down	2nd School of Choicefield type drop-down

Reason For Request*field type drop-down
Name(s) of Sibling(s)field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Grade of Siblingfield type number
Other Reason for Request*field type multi line
Input blocked. Maximum character limit of 255 characters reached.
field type checkbox
Medical
field type checkbox
Transportation
field type checkbox
Child Care
field type checkbox
Return to school within residence boundary area
Employee School Site*field type drop-down
Should this request be granted, I agree to furnish any transportation needed for my child to and from school. I further understand that this permission, if granted, may be revoked at any time for reasons deemed sufficient by school authorities.
I understand that once my child's Form 10 has been approved, return to the school within the residence boundary will be possible only after a Form 10 application is made, space availability is determined, and district approval has been granted.
I agree to the above conditions:*field type signature
Date*field type date
Date will be captured on form submission

FOR DISTRICT USE ONLY: Approved [ ] Disapproved [ ]
Date:______/______/_________ Signed: ____________________________________
Comments: __________________________________________________________________________________________________

Chico Unified School District