Burnham School - Tuition In

Required

Parent Information

Please complete a separate application for each student.

Parent/Guardianrequired
First Name
Last Name
Must contain only numbers

TO: Region 12 School District Board of Education

RE: Policy 5118.3 - Non-resident Attendance

I, (full name of parent)* as the parent or legal guardian of (full name of student)*, am requesting his/her enrollment as a student in the Region 12 School District, pursuant to Policy 5118.3 - “Non-resident Attendance.” I have received and read Policy 5118.3 and fully understand and acknowledge that enrollment of (full name of student)* is pursuant to and in accordance with this policy.

I understand and acknowledge that if (full name of student)* is enrolled in the Region 12 School District in accordance Policy 5118.3, it is for the (2026-2027)* school year only. I also acknowledge and understand that the Region 12 Board of Education may review this enrollment at any time. In its review, the Board of Education may find that the costs associated with the enrollment of my son/daughter/ward have exceeded annual tuition fees and/or circumstances have resulted in additional costs to the district. The Region 12 Board of Education may exercise its discretion and increase its tuition fees at any time, provided such fees are justified by a substantial increase in cost to the district, for continued enrollment, and/or deny enrollment in a subsequent year.

 

I have read and agree to the above.required

Student Information

Student Full Namerequired
First Name
Middle (optional)
Last Name
Must contain a date in M/D/YYYY format
Please enter NA if Not Applicable.
Note: We require Academic, Attendance and Discipline records as well a copy of IEP or 504 plans (if applicable).
 
We will be requesting records from your school once you upload the release linked below.
 
Applications cannot be considered until a release for records has been received.
 
If you have any issues uploading the release please email CavaleaC@region-12.org.

Please click the link below to access the form.

Release of Information Form PDF

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