Non-Resident Student Tuition Application Date of Application: _______________________ Along with the information below, please provide copies of the following documents in order for the application to be reviewed: o For students entering grades 1-6, Report Card reflecting all grades for the prior school year o For students entering grades 7-12, Transcript reflecting all secondary-level coursework o Any/all records of discipline regarding the applicant student Student Name: ___________________________ Date of Birth: _____________ Parent/Guardian Name(s): _________________ Phone Number: ___________ Address:___________________________________________________________ School District: ___________________________ Current School: ___________ Grade Level in Current School Year: __________ Contact Information for Current School District: Contact Name: __________________ Title:______________________ Phone Number: _________________ Email Address:______________ Please Indicate if Student Has: Individualized Education Program (IEP): Yes _______ No_______ 504 Accommodation Plan: Yes________ No_______ Other Health Plan: Yes________ No_______ Note: If Student has an IEP, 504 plan or other health plan, please attach to this application. Reason for Application to Attend Ramapo Central: _________________________ __________________________________________________________________ Requested Enrollment Date:_______________

I have read the Ramapo Central School District Board of Education Policy Number 5152 regarding Admission of Non-Resident Students. I give permission to the Ramapo Central School District to contact my child’s current school district for more information regarding my child. I understand that, if my child is accepted to attend Ramapo Central Schools, I will be responsible to pay the tuition pursuant to the guidelines listed on the appended document. I understand that late or missed payment will result in my child’s removal from Ramapo Central Schools. I affirm that the statements made on this application (including any attached papers) are true under the penalties of perjury. I understand that all statements are subject to verification and that a material misstatement or fraud will automatically disqualify my child from being enrolled by the Ramapo Central School District as a nonresident student. Parent/Guardian Signature: ___________________________ For District Use Only: Pupil Personnel Services Administrator • Date of Receipt of Application: ________________ • Approval: Yes _________ No _______________ • Signature: ___________________________________ Principal • Date of Receipt of Application: ________________ • Approval: Yes__________ No________________ • Signature:____________________________________ Superintendent • Date of Receipt of Application: _________________ • Approval: Yes__________ No________________ • Signature:____________________________________



Non-Resident Student Tuition Appendix Tuition Fees and Schedule 2016-2017 Payment Must Be Made By Check to: Ramapo Central School District, in person or by mail to 45 Mountain Avenue, Hillburn, NY 10931, attention: Accounts Payable Elementary Student: Grades K – 5 Tuition: $11,000 for full year Payment Schedule: • 50% payment due by September 6, 2016 • 50% payment due by January 2, 2017 Secondary Student: Grades 6 – 12 Tuition: $14,000 for full year Payment Schedule: • 50% payment due by September 6, 2016 • 50% payment due by January 2, 2017