New Elementary Transfer Student Form

Out-of-District Application

In-District Transfer Application

School Yearrequired

Neighborhood (Home) Schoolrequired

Other Specify required

What is your Neighborhood (Home) School?

School Presently Attendingrequired

Other Specify required

What Neighborhood (Home) School does your learner presently attend?

I hereby request that my learner be permitted to attendrequired

(Name of receiving school)

ALL TRANSFERS WILL BE DISCONTINUED AT THE END OF THE CURRENT SCHOOL YEAR

Parent/Guardian's Namerequired

Parent/Guardian's Addressrequired

Street Address

City, State

Zip Code

Home Phone#required

Work Phone#

Email Addressrequired

Student's Namerequired

Date of Birthrequired

Must contain a date in M/D/YYYY format

Has the student ever been suspended or expelled from school?required

Yes

No

Describe the circumstances (including dates and duration).required

Reason(s) for requesting attendance in this schoolrequired

Special instructional programs in which the applicant student is currently enrolled. (For example: vocational, foreign language, remedial, special education, gifted/talented, etc.)required

Do you have another student you would like to add to this transfer application?

Yes

No

Second Applicant: Student's Namerequired

Second Applicant: Date of Birthrequired

Must contain a date in M/D/YYYY format

Second Applicant: Has the student ever been suspended or expelled from school?required

Yes

No

Second Applicant: Describe the circumstances (including dates and duration).required

Second Applicant: Reason(s) for requesting attendance in this schoolrequired

Second Applicant: Special instructional programs in which the applicant student is currently enrolled. (For example: vocational, foreign language, remedial, special education, gifted/talented, etc.)required

Do you have a third student you would like to add to this transfer application?

Yes

No

Third Applicant: Student's Namerequired

Third Applicant: Date of Birthrequired

Must contain a date in M/D/YYYY format

Third Applicant: Has the student ever been suspended or expelled from school?required

Yes

No

Third Applicant: Describe the circumstances (including dates and duration).required

Third Applicant: Reason(s) for requesting attendance in this schoolrequired

Third Applicant: Special instructional programs in which the applicant student is currently enrolled. (For example: vocational, foreign language, remedial, special education, gifted/talented, etc.)required

Specify transportation arrangements that will be made by the parent/guardian.required

A transfer to another district school is a privilege we agree to extend to your student(s) under the following conditions:

1. Regular attendance is required including arrival and departure time as specified by the school.

2. School rules and procedures are followed with no major discipline violations.

3. If requested school has adequate capacity, space and staffing.

Parent/Guardian Signaturerequired

I accept the above conditions and understand District #25 maintains the right to review and rescind the transfer if any of the conditions are not consistently met.

Daterequired

Must contain a date in M/D/YYYY format