Secondary Intra-District Transfer Request Form

SECONDARY INTRA-DISTRICT TRANSFER REQUEST
THIS TRANSFER REQUEST IS VALID ONLY FOR THE 2020-21 SCHOOL YEAR. YOU MUST REAPPLY YEARLY.
Parent/Guardian *

Prefix First Name Middle Name Last Name Suffix
Date *
Phone Number *

Area Code Phone Number
Current Address *

Street Address

Street Address Line 2

City State

Zip Code Country
Email *
example@example.com
Number of Student(s) *
Maximum 4 Students

Student 1
Name of Student *

Prefix First Name Middle Name Last Name Suffix
Grade *
6 - 12
Current School *
What school does this student currently attend?
Transfer School *
What school are you requesting a transfer to?
Transfer Start Date *
Has this student previously had an approved transfer? *

Yes No
Reason for Transfer Request *
If request is for Child Care reasons, include name, address and phone number of child care provider.

Student 2
Name of Student 2 *

Prefix First Name Middle Name Last Name Suffix
Grade *
6 - 12
Current School *
What school does this student currently attend?
Transfer School *
What school are you requesting a transfer to?
Transfer Start Date *
Has this student previously had an approved transfer? *

Yes No
Reason for Transfer Request *
If request is for Child Care reasons, include name, address and phone number of child care provider.

Student 3
Name of Student 3 *

Prefix First Name Middle Name Last Name Suffix
Grade *
6 - 12
Current School *
What school does this student currently attend?
Transfer School *
What school are you requesting a transfer to?
Transfer Start Date *
Has this student previously had an approved transfer? *

Yes No
Reason for Transfer Request *
If request is for Child Care reasons, include name, address and phone number of child care provider.

Student 4
Name of Student 4 *

Prefix First Name Middle Name Last Name Suffix
Grade *
6 - 12
Current School *
What school does this student currently attend?
Transfer School *
What school are you requesting a transfer to?
Transfer Start Date *
Has this student previously had an approved transfer? *

Yes No
Reason for Transfer Request *
If request is for Child Care reasons, include name, address and phone number of child care provider.

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The following conditions must be met if this transfer request is approved:
- You must reapply yearly for transfers.
- You must provide transportation for your child to the requested school.
- You must ensure that your child arrives at school on time on a regular basis.
- You must notify the school if you move or change your phone number.
- If your child has attendance or discipline issues this transfer may be revoked.
- If you fail to get your child to school on time or to pick him/her up on time this transfer may be revoked.
If your transfer request is denied, you may appeal ONE time during the school year. Please note than many factors influence transfer request approvals, including class size limits and impact of transfer on student academic performance.

Please read and sign:
- I have read and understand the conditions outlined above.
- The information provided is true and correct to the best of my knowledge.
Parent/Guardian Signature *

First Name Last Name
Signature *

Clear
Reviewed By *

Patti Hayden Collapse
Patti Hayden *

Approved Denied
Patti Hayden Signature *

Clear

Rachel Young Collapse
Rachel Young *

Approved Denied
Rachel Young Signature *

Clear

JoAnn McCowan Collapse
Transfer Status *
Notify School *
JoAnn McCowan Signature *

Clear

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Notes
Should be Empty: