Student Transfer Request
Date of Transfer Request Made
*
-
Month
-
Day
Year
Hour Minutes
AM
PM
AM/PM Option
Student's Name
*
First Name
Middle Name
Last Name
Suffix
Student's Date of Birth
*
-
Month
-
Day
Year
Grade Level
*
Please Select
P4
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
School Last Attended
*
Did the student have any discipline issues at the previous school. (This includes any ISS or OSS)
Yes
No
If you answered yes to the above question, please briefly describe the incident(s).
Was the student absent more than 10 days in a semester without a doctor's note?
Yes
No
Does the student have an IEP?
Yes
No
If you answered yes to the above question, please list the student's primary and secondary placement. (i.e. SLD, OHI, SLD, AU, Speech...)
Please upload a copy of the most recent IEP, if applicable.
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PARENT/LEGAL GUARDIAN AGREEMENT
*
By checking this box, as the parent/guardian of the student above, I verify that the information is accurate, and I agree to the terms of the transfer request.
Parent/Guardian's Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to Student
*
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian's Email Address
example@example.com
Parent/Guardian Signature
*
Submit
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