ENROLLMENT / EXCLUSION FORM
To Implement Sections 16-28-40 through 16-28-45, Code of Alabama, 1975
Follow instructions on the back of this form. Print or type all information.
Social Security No.:
Driver's License No.:
Date of Birth:
11. ENROLLMENT* SCHOOL OR GED OR JOB TRAINING PROGRAM
(School or in GED or Job Training Program)
Job Training Program
Enter the actual date of compliance or noncompliance in the blank located to the left of the appropriate statement.
NOT IN COMPLIANCE
Is not enrolled.
Withdrew due to circumstances beyond
Has accumulated more than 10 consecutive
his or her control.*
or 15 cumulative unexcused absences during
a single semester.
Has obtained a GED Certificate.
(Only for students enrolled in secondary school)
The applicant was previously reported as
Is not making satisfactory progress.
being noncompliant. As of this date, the
(Only for GED students)
student has complied.
Enter the actual date in the blank located to the left of the appropriate statement.
Is a parent with the care and custody of a minor
or unborn child.
Is the sole source of transportation for the parent(s).
Enter the beginning date of employment.
Place of Employment
Is gainfully and substantially employed.
*Defined on the back of this form.