Please enter the information below, fields with an asterisk(*) are required.

Student Last Name*: Student First Name*: Student Middle Initial: Grade for 2020-2021*:

EACS School Applying to*:   Applying for*:

Gender: Male Female Date of Birth*:

Names of Parents/Legal Guardians:

Last Name*: First Name*:

Last Name: First Name:

Home Address*:

City*: State*: Zip*:

Telephone: Day*: Evening:


Check if any of the following apply:

Student has a sibling/household member currently attending an EACS school under an approved tuition transfer status.

Student is a dependent of a current EACS employee. Employee Name:

Student had legal settlement in EACS and has been attending EACS schools immediately before submitting this application, but has now moved out of the district.

Check if Applicable:

This student currently receives Special Education Services

This student currently has an active 504 Plan

List all related disabilities or medical conditions:

(EACS Special Services will review this application and confirm availability of services at the requested school.)

Does the household include other students who are ALSO applying to be NEW tuition transfer students this school year? You must still submit a separate application for each student.

Name: School applying to:

Name: School applying to:

School student attended immediately prior to request for tuition transfer:

Is student in good standing at the school? Yes No

Name of School: School Phone:

City: State:

In the last 12 calendar months, has the student been suspended, expelled, denied attendance, or otherwise separated from school?* No Yes
If yes, list the reason and number of days suspended, expelled or separated from school.

During the 2019-2020 school year, did the student accumulate seven (7) or more UNEXCUSED absences from school OR late arrivals to school?* Yes No

Which high school corresponds to the attendance are the student LIVES in (regardless of current grade)?*

I have read and understand the information provided on the tuition transfer request sheet and are requesting for my child to attend:

Grade: for the 2020-2021 school year at:

By submitting this application, I give East Allen County Schools permission to request and obtain copies of my student's school discipline and school attendance records from the 12 months preceding the transfer as needed for the purpose of verifying the student's eligibility to transfer to East Allen County Schools. This information may be released verbally or in writing. I hold harmless East Allen County Schools in regard to the use of information authorized for release.

Name of Guardian Agreeing:

IMPORTANT : Check this box if you wish to be contacted to select an alternate EACS school for this application if your first-choice school is full/at capacity and your application cannot otherwise be approved.


Prior to clicking Submit, please print a copy for your records.