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Series 502.4.1P - Statewide Enrollment Options Form

Adopted: December 1997
Revised:  August 2016

Revised August 2016

Statewide Enrollment Options Form
Required form for all Minnesota school districts

Return to:
ISD 196 Student Information 3455 153rd Street West Rosemount, MN 55068
Fax: 651-423-7787

Section 1: To be completed by the student’s parent/guardian
PARENTS: email, mail or fax this form to the superintendent’s office of the non-resident district where you would like your student to attend school. Do not mail to the Minnesota Department of Education (MDE). See separate instructions for important January 15 deadline information that may apply. Parents must currently live in Minnesota to submit this form.

Parent/Legal Guardian Information
Last Name:     First Name     MI:     
Phone: Home:      
Street Address:         City:     State:     _ZIP:     
Resident District:_     _     _     _     _     _
District #:     City:     _
District of Choice (Non-Resident School District):  Rosemount - Apple Valley - Eag_an Public Schools    _
District #:
_ City:

District of Choice Fax Number: 651-423-7787
Student Information
Student Name: Last:     First:     MI:     _ Will the student be at least age 5 and under age 21 by September 1 of enrollment year?
No. If no, the student must meet the age exceptions listed in the instructions (page 3). If the exceptions don't apply, do not use this form. Contact the district to explore other options.
Current Grade Level:     Grade Level Desired:     Desired Date of Enrollment:       Please rank the schools in the non-resident district in order of preference:

Special Situations. See instructions (page 3).

Sibling preference: student has a sibling currently open-enrolled in this non-resident district.

Employee child preference: Student has parent or legal guardian who is a Minnesota resident who is an employee of the non-resident district.

Early Childhood Special Education (birth to age 5). Does this child ideally need early childhood special education services to start immediately?
  Yes.    No.
(Note to families: If the January 15 deadline applies, request a Non-resident Agreement to begin services for your child before this form takes effect.)
Family move: The student’s resident district changed after December 1 prior to the school year requested, waiving deadlines.

Early kindergarten enrollment request (child not age 5 by September 1).

Student is currently expelled under Minnesota Statutes, section 121A.45 for a reason listed in Minnesota Statutes, section 124D.03, Subdivision 1.

Do not disclose additional information to the non-resident district until a seat is offered in writing, at which time districts will request birthdate, records and other information.
I hereby verify that the above information is true and correct to the best of my knowledge and belief.

Signature of Parent/Legal Guardian:     _ Date:      

Section 2: To be completed by the non-resident district
Non-resident district: Notify parents/guardians by February 15 (or no more than 90 days after receiving applications that come later through an Achievement and Integration School Choice Program) of approval or disapproval of application.
Families must accept or decline the offer by March 1 or 45 days later. After receiving the commitment to attend, the non- resident district must notify the resident district by March 15 (or 30 days after initial receipt if form filed after January 15) of the student’s intent to enroll. Report all rejected applications to the Minnesota Department of Education by July 15. Please expedite applications for families seeking Early Childhood Special Education services (ECSE may not be closed).

Date Application Received:      
District Name:  Rosemount-Apple Valley-Eagan Public Schools   District Number: 196     District Contact Name: Kim Reis        Title: Student Information Supervisor Telephone Number: 651-423-7644    
Does the January 15 deadline apply?    Yes    No:    One or both districts receive AI funding from MDE.
Family moved to resident district on December 1 or later.

Will the student have priority in a lottery?    No    Yes, this applicant has priority based on the following:
Sibling of currently open-enrolled student.
MDE-approved Achievement and Integration school choice plan.
Child of Minnesota resident who is a district employee.

On the basis of information provided in the above application, and with respect to district policies and procedures, the above student will be assigned to:
School Building Name:         _ Starting Date:     _
Grade Level:     _
The non-resident district has denied the request for open enrollment because of the following reason(s) allowed in Minnesota Statutes, section 124D.03. Check all that apply.

The January 15 deadline applies and was not met; situations that would have waived the deadline are not present. See Statewide Enrollment Options Instructions or Minnesota Statutes, section 124D.03, Subdivision 3.

Statutory enrollment cap has been reached. (Minn. Stat. § 124D.03, Subd.2)

Grade is closed district-wide by board action. (Minn. Stat. § 124D.03, Subd. 2 and Subd.6)

District has denied the application because of specific expulsion reasons allowed in law. (Minn. Stat. § 124D.03, Subd.1)


Superintendent/Responsible Authority:     Date:     _

Contact MDE for a translated version of this form.


Statewide Enrollment Options Instructions
GENERAL INFORMATION AND INSTRUCTIONS: Kindergarten through 12th grade students (including 12th grade transition services) as well as pre-kindergarten children in very specific circumstances may apply to attend a public school outside of their resident district (Minn. Stat. § 124D.03) as long as the parent or legal guardian is currently living in Minnesota and the student is requesting to attend a regular Minnesota public school district. This Enrollment Options Program is not for inter-state transfers, Minnesota charter schools, or enrollment into a Minnesota alternative school for
at-risk students. Use one application form per student per requested district. Complete and sign Section 1 of the Statewide Enrollment Options Form and send to the non-resident district’s superintendent’s office. Please do not send the form to MDE.

General age requirements are ages 5-21 (without high school diploma) by September 1 of enrollment year: AGE EXCEPTIONS:
•    Early Childhood Special Education. The student is under age 5 and has been identified through a formal assessment process in the resident district as needing an individual education plan (IEP) for early childhood special education. Under Grade Level, write NA (not applicable). The IEP does not need to have been developed. Under Special Situations, check early childhood special education.
•    Early Kindergarten Entrance. The student has met all requirements of the non-resident district for consideration for early entrance to kindergarten such as a September or October birth date, assessment testing and a trial period of enrollment and the non-resident district has agreed to consider an open enrollment for the child for early entrance to kindergarten. Do not submit this form in this situation without first working with the non-resident district to determine eligibility. Under Grade Level, write K. Under Special Situations, check early K entrance request.
Deadlines and exceptions to deadlines:
Applications must be sent to the non-resident district by January 15 in order to enroll in the following school year, unless:
•    One or both districts has a Minnesota Department of Education Achievement and Integration plan, in which case there is no deadline and enrollment may begin at any time after notification of acceptance. (Minn. Stat. § 124D.03, Subd. 4).
•    OR, the student moved into the resident district on or later than December 1. (Minn. Stat. § 124D.03, Subd. 7).
•    OR, other unusual situations apply under Minnesota Statutes, section 124D.03, Subdivision 7.
Acceptance or denial of open enrollment cannot be based on previous academic achievement, athletic or other extracurricular ability, disabling conditions, proficiency in the English language, previous disciplinary proceedings or the student’s district of residence unless the resident district and non-resident district are working together in an MDE- approved Achievement and Integration School Choice Program. (Minn. Stat. § 124D.03, Subd. 6.).

Families may indicate their preferences for school sites or programs within the district; if unavailable, districts will offer options in the family’s stated order of preference at other sites unless the grade level or open enrollment has been closed by board action. Families may apply in more than one district. Use one form per child per district.
Do not disclose specific special needs of students on the Statewide Enrollment Options Form; provide this information after an enrollment spot is offered.
Currently expelled students: Non-resident districts may, but are not required to, reject applications from students currently expelled as defined in Minnesota Statutes, section 121A.45 and Minnesota Statutes, section 124D.03, Subdivision 1.
Notice of acceptance of application: You can expect to receive an approval or disapproval from the
non-resident district by February 15, or, when applying through the waived deadlines for Achievement and Integration districts, 90 days after applying for the current or upcoming school year. (Do not apply for statewide enrollment options further in advance than for the upcoming school year.) MDE asks school districts to process requests for students who have newly moved or children in need of early childhood special education as soon as possible without delays. School districts who have more applications than they can accommodate must hold lotteries to determine which students will receive spots. A priority lottery must be held for siblings of currently open-enrolled students, students who are part of a Minnesota Department of Education approved Achievement and Integration plan, and children of district employees who are Minnesota residents. Statewide Enrollment Options lottery procedures must be approved by local school board and posted on the school district website.
If the non-resident district notifies you that your application has been accepted:
Notify the non-resident district as to whether you are accepting the offer of enrollment by March 1, or, if you applied under a no-deadline situation, 45 days after notification. The non-resident district must notify the resident district that your student is changing enrollment by March 15 (or 30 days after notice from you that you are accepting the enrollment if the January 15 deadline did not apply). Visit the non-resident district office at least 10 days before the above starting date to complete all enrollment forms.

Parents or guardians of students with special needs: please contact the district about creating an IEP team as soon as possible after accepting an offer of enrollment in a non-resident district.

Transportation: The school district will give you information regarding transportation if you request it from a bus stop in that district. (Minn. Stat. § 123B.88, Subd. 6; Minn. Stat. § 124D.03, Subd. 8.).

Obligation to attend at least one year. By accepting this enrollment, your student is obligated to attend the non-resident district during the upcoming school year. You do not need to reapply in subsequent years for your student to remain enrolled unless you move out of your current district. If you move into another Minnesota non-resident school district, you will not lose your seat but do need to submit an updated Enrollment Options Form. Note: you do need to apply again for siblings but the siblings must be given a preference if open enrollments requests exceed available seats.

To return to your resident district after one year in the new district, notify your resident district that you are returning by January 15 for the following fall.

If your application was denied, districts:
(1)    Must indicate the provision in state law that applied.
(2)    Must report denied applications to the Minnesota Department of Education by July 15.
(3)    May inform you that your application was rejected because you missed the January 15 deadline. In this case, ask your resident district to form a non-resident agreement with the non-resident district for the upcoming year--both districts must agree. However, you will need to apply again next year through the regular open enrollment process and meet the January 15 deadline. That way, your student’s enrollment is not subject to year-to-year mutual agreements between districts. (Minn. Stat. § 124D.03, Subd.6).