Exhibit JBC(1)-E(4): Homeless Students - 4

JBC(1)-E(4) · Exhibit · Last revised 02/01/2018 · Adopted 03/11/2013

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EDUCATION OF HOMELESS CHILDREN AND YOUTH
                                       PARENT DISPUTE RESOLUTION


This form should be completed by parent, caretaker, or unaccompanied youth when a dispute arises regarding school
selection or enrollment within three days business days of registration/ enrollment. The school should immediately
email or fax the Parent Dispute Resolution Form to the Homeless Education Liaison office at (678) 676-1831.


Date: ____________________________
Parent /Guardian/ Student: ____________________________________________________                    Phone: _______________________
I wish to appeal the enrollment decision made by: _______________________________________________________________
I have been provided with:
       A written explanation of the school’s enrollment decision by principal.
       A Copy of the School Dispute Written Notification of Enrollment form signed by the principal.
       A copy of the Dispute Resolution Process for students experiencing homelessness.
       Contact information for the local Homeless Education Liaison.

 Student’s Name                                      D.O.B.       Grade        Previous Enrolled            Requesting School of
                                                                                    School                      Enrollment




Optional: You may include a written explanation to support your appeal in the space below:
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________


Signature___________________________________________________________________              Date _________________________________

The DeKalb County School District does not discriminate on the basis of race, color, religion, sex, age, national origin, disability,
veteran status, marital status, or sexual orientation in any of its employment practices, educational programs, services or
activities. For additional information about nondiscrimination provisions, please contact Student Support & Intervention located
at 1701 Mountain Industrial Boulevard, Stone Mountain, GA 30083. Phone number 678-676-1200.


JBC (1) –E (4), Revised July 2017

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