Student Services Division
501 SHERMAN STREETLITTLE ROCK, AR 72202PHONE (501) 447-2950 FAX (501) 447-2982
PETITION FOR ENROLLMENT UNDER ACT 624 OF 1987
I,
petition my child(ren) or wards, as listed below, now residing in
School District for your Location
in the county of
County Name
Arkansas, be enrolled in the Little Rock School District during the time I am a public school employee in said district pursuant to Act 624 of 1987 of the State of Arkansas.
First Student
Student 1 Name
Student 1 Birthdate
Student 1 Grade
Second Student
Second Student Name
Second Student Birthdate
Second Student Grade
Third Student
Third Student Name
Third Student Birthdate
Third Student Grade
Fourth Student
Fourth Student Name
Fourth Student Birthdate
Fourth Student Grade
What is your school preference?
Please list your school(s) preference in order:
School First Choice
School Second Choice
School First Choice
Signature Information
Signature of Petitioner
Address
City, State Zip
Contact Number
Place of Employment
DATE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
Should be Empty: