About this Form
Form number: 336-16
Last revised: February 2017
INSTRUCTIONS: Parents/guardians of private/parochial school students with a disability may request a different MCPS school if there is a hardship in using the home school location to access special education services for their student. If there is a change to the service school location, transportation may be requested, but is not guaranteed. If the parent/guardian of a parentally-placed private/parochial school student with a disability would like to request a different MCPS service school, they should complete Part I of this form and submit the form to the coordinator of the private/parochial school office in the Division of Business, Fiscal, and Information Systems (DBFIS), CESC, 850 Hungerford Drive, Room 225, Rockville, MD 20850.
Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat