Cash Tuition Request Form

Huntington County Community School Corporation

Student Cash Tuition Transfer Form

Language Preference

Have you applied to attend a HCCSC School before:

YesNo

This request is for school year*

Requested School Year*

Student 1 Full Name

First NameLast Name

Grade Level*

Requested HCCSC School*

Requested HCCSC School -Text

Requested HCCSC School Email -1

example@example.com

School of Residence*

School Corporation of Residence*

Student 2 Full Name

First NameLast Name

Grade Level

Requested HCCSC School-2

Requested HCCSC School -2 Text

Requested HCCSC School Email -2

example@example.com

School of Residence

School Corporation of Residence

Student 3 Full Name

First NameLast Name

Grade Level

Requested HCCSC School -3

Requested HCCSC School -3 Text

Requested HCCSC School Email-3

example@example.com

School of Residence

School Corporation of Residence

Residing Address*

Mailing Address (if different)

Parent/Guardian 1*

Parent/Guardian 1 -Phone*

Parent/Guardian - Email Address*

example@example.com

Parent/Guardian 2

Parent/Guardian 2 - Phone

Parent/Guardian - Email Address

example@example.com

Comments*

As the parent/guardian of the above named student(s), I am requesting enrollment at the named school(s) for said school year. I/We understand that this application and approval are an annual request and that I/We are ultimately responsible for the transportation to and from school, unless otherwise qualified for McKinney Vento Homeless Assistance. I/We understand and agree to sign and return the agreement from the HCCSC Administration Office.

Parent/Guardian -1 Signature*

Date*

Date

Parent/Guardian -2 Signature

Date