Hatfield Public Schools
34 School Street
Hatfield, MA  01038
Tel:  (413) 247-5641                    Fax:  (413) 247-0201



SCHOOL CHOICE APPLICATION
2010– 2011



Student’s Name:______________________________Date Of Birth:_______________

Formal Name:  Last:                ____________________________________

First:            ____________________________________

Middle (Full Name):     ____________________________________

Name of last school attended:______________________________________________

Address & Tel. #:________________________________________________________

Anticipated Grade for 2010-2011 school year:_________________________________

Do you have another child already admitted as a School Choice student?

Yes     __________        No     __________

If so, grade level(s) of sibling(s)  ___________________________________________

Why do you wish to enroll your child in the Hatfield Public Schools?









Hatfield Public Schools can provide normal Special Education/504 ancillary services
such as classroom support, speech and remedial assistance.  We currently have no
openings in our behavioral Autistic program, or specialized special education programs.

Does your child have a current Individual Education Plan (IEP)? Yes_____No_____

Does your child have a current 504 Plan?     Yes_____     NO_____



Any false statements or omissions could disqualify the applicant for the consideration for enrollment and could be considered justification for immediate dismissal if discovered at a later date.


The Hatfield Public Schools are committed to providing all students equal access to all educational programs and activities, and shall not discriminate on the basis of race, color, national origin, creed, age, handicap, gender or sexual orientation.



Parent/Guardian Name (Printed): __________________________________________

Parent/Guardian Signature:  ____________________________Date:______________

Home Address:__________________________City:_________________Zip:_______

Mailing Address:________________________City:_________________Zip:________

Daytime Telephone:_____________________Evening Telephone:________________

OFFICE USE ONLY


Date Accepted:  _________________________________________________________

Date Parent/Guardian(s) Notification Sent:___________________________________

Date Parent/Guardian(s) Accepts Placement:_________________________________

Home Address:__________________________City:_________________Zip:_______

Mailing Address:________________________City:_________________Zip:________

Daytime Telephone:_____________________Evening Telephone:________________

OFFICE USE ONLY


Date Accepted:  _________________________________________________________

Date Parent/Guardian(s) Notification Sent:___________________________________

Date Parent/Guardian(s) Accepts Placement:_________________________________