Public School Change Request - School Consolidation and School Closure

Public School Change Request Form - School Consolidation and School Closure
Instructions for Completing This Form:

Complete only the section that applies to the type of change you are requesting. Please do not complete multiple sections on the same form. This form must be submitted by April 1 of each year.
Use this form to request a change for one of the following:

School ConsolidationSchool Closure
Section A - Primary Contact Information
Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Request

MonthDayYear
Date
Section B - Change Type
What type of change are you requesting?

School Consolidation - Go to Section CSchool Closure - Go to Section D

Section C - School Consolidation

If you are requesting a grade reconfiguration, please complete Section C only.
List the schools currently involved and identify the school into which they will be consolidated. Include any relevant information about changes to grade structure or school organization (e.g., Lincoln Elementary and Jefferson Elementary will consolidate into Roosevelt Elementary beginning in the 2026-2027 school year).
Post-Consolidation School Information
School District Name
School Name
Grade Configuration
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Effective Date of Consolidation

MonthDayYear
Date

Section D - School Closure

If you are requesting a school closure, complete Section D only.
Reason for Closure
Briefly explain the rationale for closing the school (e.g., declining enrollment, budget constraints, consolidation).
Impact on Students
Where will students be reassigned? Will transportation or services be provided?
School District Name
School to be Closed
Grade Levels Served
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Effective Date of Closure

MonthDayYear
Date

Section E - Supporting Documentation
Date of Board Approval

MonthDayYear
Date
Upload your school's dated and signed board minutes indicating the approval of requested changes.

Cancelof

Section F - Submission/Acknowledgement

Thank you for submitting your public school change request. The ND Department of Public Instruction will review your submission and contact you if any additional information is required. Please retain a copy of your responses for your records.
Should be Empty:

Public School Change Request Form - School Consolidation and School Closure