MCKAY SCHOLARSHIP PROGRAM



John M. McKay Scholarship Public to Public Student Transfer Application

2019-2020

Prior to completing this application, you must first file an intent to participate in the McKay Scholarship Program at . To be eligible for McKay, the student must be currently enrolled in a Florida public school; have been reported during the October 2018 and February 2019 FTE surveys; applying for enrollment in grades K-12; and have an active IEP or 504 Plan. You may use this application to request a public school other than the one to which assigned. Space at each location is limited. The school must be able to accommodate your child in their grade of enrollment and have the ability to provide the services identified on the IEP/504 Plan. Transportation is not guaranteed.

Demographic Information: Complete this section based on the student’s current information.

Student Name: _________________________________________________ Student ID #: ___________________

Student’s Date of Birth: _______/_______/_______ Check One: IEP _________ 504 Plan __________

2018-2019 School: __________________________________________________ 2018-2019 Grade Level: _______

Address: _______________________________________________________________________________________

City: _______________________________________ State: ______________________ Zip Code: _____________

Parent(s)/Guardian Name: _________________________________________________________________________

Phone: _______________ Work Phone: ______________ Email Address: __________________________________

School Choice Request: Complete this section based on the student’s information for the 2019-2020 school year

Neighborhood/Zoned School: ___________________________________________ Grade Level: _______________

School Choice Request: _________________________________________________________________

By signing this form, I certify that I am the Legal Guardian and I have read and understand the guidelines for the McKay Scholarship Program Public to Public Option.

________________________________________ ____________________________________

Parent/Guardian Signature Date

Submit this application to the Exceptional Education/Student Services Office by US Mail, fax or e-mail listed below.

Torri Clark-Amezcua

Exceptional Education/Student Services Received By _____________________________

4037 Boulevard Center Drive

Team Center, Building B, 3rd Floor Date Received ___________________________

Jacksonville, FL 32207

PH (904) 348-5719 FAX (904) 858-3625

E-Mail address: clark-amet@ 

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