EmailMe Form - Waiver for Eligibility of Displaced Students

New TAPPS City *

Name of TAPPS School *

Person Submitting request *

First Last

Email

Student Information

Name

First Last

Grade *

9

10

11

12

Date of Birth *

MM / DD / YYYY

Name of Temporary Guardian (if any) *

First Last

Temporary Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Previous City *

Previous School *

Date of enrollment at the new school *

MM / DD / YYYY

First day of attendance at the new school *

MM / DD / YYYY

Was the student 19 before September 1 of current school year? *

Yes

No

Is the student enrolled in fewer than 4 courses per day? (TAPPS By-Laws Section 82) *

Yes

No

Did the student first enroll in ninth grade more than 4 years ago? (TAPPS By-Laws Section 84) *

Yes

No

Date of enrollment in ninth grade *

MM / DD / YYYY

Did anyone from the new school contact the student prior to enrollment in the new school? *

Yes

No

If yes, please explain.

Was the student ever prohibited from participation at the previous school? *

Yes

No

If yes, please explain.

Is the student receiving finanacil aid at the new school? *

Yes

No

If yes, please explain.

Reason for completion of this form *

It shall be the responsibility of each school to have on file the following required forms for each student who participates in any practice (before, during or after school), scrimmage or game: Student Acknowledgement of Rules Form and Medical History Form (recommended). The student is in compliance with Section 87 of the TAPPS By-Laws in regard to solicitation, inducement and tampering. Incorrect and untrue information proveded by the parent or student could cause ineligibility and would therefore result in teh forfeiture of any contests in which the student particpated in addition to other penalties which may be imposed. The following signatures certify to the best of your knowledge, that all information presented on the form is true and correct.

Student Name *

First Last

Parent Name *

First Last

Athletic Director *

First Last

Head Administrator *

First Last