• FORM I DOE 7/06

    ELECTION TO ATTEND SCHOOL WHERE THE PARENTS ARE DIVORCED OR SEPARATED

    This agreement is prepared by the State Superintendent of Public Instruction, as required by Indiana Code 20-26-11- 3. Form I is to be signed by both parents except where the student has been abandoned by the custodial parent. 
     
    Student Information
    Name: (last)_________________________________ (first)_______________________________(mi)___________ (street)________________________________(city)_________________________(state)______(zip code)_______ 
     
    Last school corporation attended: __________________________________________________________________
    Current School Corporation: Northwest Allen County Schools 
     
    Parent Information
    Mother:
    Name: (last) ________________________________(first)_________________________________(mi)__________ (street)____________________________________(city________________________(state)_____(zip code)______ 
     
    Father:
    Name: (last) ________________________________(first)_________________________________(mi)__________ (street)____________________________________(city________________________(state)_____(zip code)______ 
     
    Parent with whom the student will live:____________________________________________________________
     
    ____________________________________ agrees to assume all the duties and be subject to all the liabilities of the parent of
          (parent with whom student will live) 
    _______________________ with respect to dealing with the school corporation and for all other purposes under Indiana Code 20-26.
                (student) 
    This agreement is binding from the date signed until terminated by either parent in writing. 
     
     I affirm, under the penalties for perjury, that the foregoing representations are true.
     
    ___________________________________________                               ___________________________________________
    Name (printed)                                                                                             Name (printed) ________________________________________________                     ________________________________________________
    Signature                                                                                                      Signature
     
    ________________________________________                                     ________________________________________
    Date                                                                                                              Date
     
    Acknowledged by ______________________________________ on behalf of Northwest Allen County Schools
                                                       (name and title)                                                               (school corporation)
    Date_____________________________  
     
    Sworn and subscribed before me this _________ day of ____________________, 20_____.
     
    _______________________________ resident of _____________ County. Expires: ___________
                (notary public)
     
     
    Form Updated: 8/6/10