Statewide Enrollment Options Application for
State-funded Voluntary Pre-Kindergarten or School
Readiness Plus
The Statewide Enrollment Options Application for State-funded Voluntary Pre-Kindergarten or School Readiness
Plus is the required application for participating Minnesota school districts. Please use this application for 4-
year-olds with or without an Individual Education Program (IEP) applying for voluntary pre-kindergarten or
school readiness plus open enrollment. Please use the
General Statewide Enrollment Options Application for K-
12 and Early Childhood Special Education open enrollment.
IMPORTANT NOTE: Do not disclose other information to the non-resident district until a seat is offered in
writing. At that point, the district will request information such as special needs, birth date, race, ethnicity,
academic and other records.
Section 1: To be completed by one or both of the child’s parents/guardians
Child Information
Child’s Last Name:
First:
Full Middle:
Birthdate (MM/DD/YYYY):
Child’s Resident School District
Resident District Name:
District Number:
City:
District of Choice (non-resident school district)
District of Choice Name:
District Number:
City:
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Identify the reason for the request to enroll in a nonresident district:
Voluntary Pre-kindergarten
Are you seeking to enroll your child in state-funded voluntary pre-kindergarten, having verified with the non-
resident district that your child meets eligibility requirements? ☐ Yes ☐ No
School Readiness Plus
Are you seeking to enroll your child in school readiness plus, having verified with the non-resident district that
your child meets eligibility requirements? ☐Yes ☐ No
Site or Program Preferences
If the non-resident school district has multiple sites/programs that serve your child’s needs, you may rank
sites/programs in order of preference. (Add more preferences if desired.)
1.
2.
3.
Enrollment Timeline
When are you seeking to enroll your child?
☐ Immediately
☐ Not immediately, but sometime during the current school year
☐ Next school year
Special Situations
Please check all that apply.
☐ Sibling preference: child has a sibling currently open-enrolled in this non-resident district.
☐ Employee child preference: Child has parent or legal guardian who is a Minnesota resident who is an
employee of the non-resident district.
☐Family move: The child’s resident district changed after December 1 prior to the school year requested,
waiving deadlines.
☐Child is a resident of City of Edina but the resident school district for the child’s Edina home is not Edina Public
Schools. Child seeks enrollment in Edina Public Schools.
☐Child is requesting a move into and/or a move out of a district that receives
Achievement and Integration
Revenue, waiving deadlines. You can check here if you do not know the answer to this: ☐
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Parent/Legal Guardian Information
The child must live with at least one parent/guardian who lives in Minnesota.
Minnesota Parent/Guardian 1
Last Name:
First Name:
MI:
Home Phone:
Work Phone:
Cell Phone:
Street Address:
City:
State:
ZIP:
Parent/Guardian 2:
Last Name:
First Name:
MI:
Home Phone:
Work Phone:
Cell Phone:
Street Address:
City:
State:
ZIP:
Physical Signature of at Least One Parent/Guardian is Required
I hereby verify that the above information is true and correct to the best of my knowledge.
Signature of Parent/Legal Guardian 1:
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Date:
Signature of Parent/Legal Guardian 2 (optional):
Date:
Submission Information
For priority consideration, please complete this application and send it to the Superintendent’s Office in the
non-resident District by January 15 before the first fall enrollment. Please do not send this application to the
Minnesota Department of Education. Use one application per student per requested district.
Applications received by the non-resident district after the January 15 deadline may qualify for exceptions to
deadline or, if not, districts may voluntarily agree to allow enrollment through a voluntary School District Non-
resident Agreement for Inter-district Enrollment.
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Section 2: To be Completed by the Non-resident District
Non-resident District: Notify parents/guardians of application approval or disapproval in writing by February 15
or no more than 90 days after receiving applications that come through an Achievement and Integration School
Choice Program If rejected, you must let families know the legal reason for denial.
Families must accept or decline the offer by March 1 or 45 days after notification that their application has
been approved. After receiving the commitment to attend, the non-resident district must notify the resident
district by March 15 (or 30 days after initial receipt if form filed after January 15) of the student’s intent to
enroll. Districts must report all counts of rejected applications and reasons to the Minnesota Department of
Education by July 15 or each year.
Date Application Received:
District Name:
District Number:
District Contact Name:
Title:
Phone:
Email Address:
Does the January 15 deadline apply?
☐ Yes, the deadline applies and it was met.
☐ Yes, but it was not met. If this is the case, contact the superintendent’s office in the resident district
immediately regarding Section 3 of this form to determine whether the resident district and your district will
agree to a Non-resident Agreement to serve the student prior to open enrollment becoming available.
☐ No, one or both districts receive Achievement and Integration funding from MDE.
☐ No, family moved to resident district on December 1 or later.
☐ No, the commissioner of education and commissioner of human rights have determined the resident
district’s policies, procedures or practices are in violation of Title IV of the Civil Rights Act (Minn. Stat. §124D.03,
subd.7).
Will the student have priority in a lottery? ☐ No ☐ Yes, based on:
☐ Sibling of currently open-enrolled student in this district.
☐ MDE-approved Achievement and Integration with specific school choice plan involving the districts.
☐ Child of Minnesota resident who is a district employee.
☐ City of Edina resident whose resident school district is not Edina Public Schools, seeking entry to the district.
Approval/Disapproval of Open Enrollment Application
☐ APPROVED
☐ APPROVED BUT WITH A NON-RESIDENT AGREEMENT for beginning year that is mutually agreed upon by
both districts. Enrollment will continue in subsequent years as open enrollment with the exception that a
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voluntary pre-kindergarten or school readiness plus student’s enrollment through a non-resident agreement
who is entering kindergarten the subsequent year may be placed in an open enrollment kindergarten lottery if
one is held. (Non-resident district: keep documentation of the agreement. Districts may document agreement
using Section 3 or another format of their choosing.)
STUDENT SITE/PROGRAM ASSIGNMENT
On the basis of information provided in the above application, and with respect to district policies and
procedures, the above student will be assigned to:
School Building Name:
Starting Date:
VPK or School Readiness Plus:
☐ NOT APPROVED
The non-resident district has denied the request for open enrollment because of the following reason(s) allowed
in Minnesota Statutes, section 124D.03. Check all that apply:
☐ The January 15 deadline applies and was not met; situations that would have waived the deadline are not
present. See Minnesota Statutes, section 124D.03, subdivision 3. Districts have not mutually agreed to a non-
resident agreement.
☐ Statutory enrollment cap has been reached for open enrollment or the enrollment cap for the requested
voluntary pre-kindergarten or school readiness plus program has been reached. (Minn. Stat. § 124D.03, subd.2)
☐ The requested voluntary pre-kindergarten or school readiness plus program is closed district-wide by board
action. (Minn. Stat. § 124D.03, subd. 2 and subd.6)
NOTIFICATION TO RESIDENT DISTRICT
Non-resident district must notify resident district or last district of attendance by March 15 or no later than 30
days after this decision. The same procedures apply to a pupil who applies to transfer from one participating
non-resident district to another participating non-resident district.
Name of Superintendent/Responsible Authority:
Signature:
Date:
Please Note: districts may not modify this form, add data fields or create alternative formats.
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