Together, Educating Every Student for Excellence
CHRISTINA SCHOOL DISTRICT
Administration Office
1899 S. College Avenue
Newark, DE 19702
Education Options
Phone: (302) 552-2665
Fax: (302) 429-4138
TDD: (800) 232-5470
DAN SHELTON, ED.D. DR. GINA MOODY
Superintendent Director, Student Services and Whole Child Support
CHRISTINAK12.ORG
The Christina School District is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, pregnancy, national origin, citizenship,
age, disability, veteran status, genetic information, sexual orientation, marital status, gender identity, or any other categories protected by federal, state, or local law.
Inquiries regarding compliance with the above may be directed to the Title IX/Section 504 Coordinator, Christina School District, 1899 S. College Ave, Newark, DE 19702;
(302) 552-2600.
SCHOOL CHOICE GOOD CAUSE FORM 2022-2023 SCHOOL YEAR
MUST ACCOMPANY 2022-2023 Delaware Standard Application for Educational Options
Name of Student _____________________________________Current Grade_ __________
Address ____
School Currently Attending_____________________________________________________________
Choice School Request _______________________________________________________________
Home Phone __________________________ Business Phone ___ _______________________
Please check (√) the “Good Cause” reason that applies and attach documentation to show the
change occurred after January 12, 2022:
_____ 1. Change in the location of family residence (required documentation includes a signed
lease, signed and dated Settlement Statement or other document which verifies the date
and location of the move.) EFFECTIVE DATE OF MOVE: _____________________
_____ 2. Change in the student’s parents’ marital status (Attach documentation)
_____ 3. Change in legal guardianship (Attach documentation)
_____ 4. Placement in foster care (Attach documentation)
_____ 5. Adoption (Attach documentation)
_____ 6. Participation in a foreign exchange program (Attach documentation)
_____ 7. Student’s participation in a substance abuse or mental health treatment program
(Attach documentation)
_____ 8. A reported, recorded and substantiated instance of bullying as defined by the Delaware
State Law (Attach documentation)
_____ 9. Similar circumstances (Attach documentation)
I understand transportation will only be provided from an existing Christina bus stop to the
requested Choice school, if space is available, and agree to abide by the School Choice Program
Guidelines of the Christina School District.
Parent/Guardian Signature: ___________________________________________________________
Date of Request: _____________________________
Rev 01/2022 jmm
