Request for Intradistrict Transfer

 

 

 

PLEASE PRINT ALL INFORMATION

     

ETIWANDA SCHOOL DISTRICT

6061 East Avenue, Etiwanda, CA 91739

"REQUEST FOR INTRADISTRICT TRANSFER"

Please check if this is a New transfer   or a Renewal (if applicable)  

School Year:

Name of Student:   Male    Female

Grade for year requested:   Age:  Birthdate:                                 Home Phone:

Parent/Guardian:                   Work Phone:

Address:   City:   ZIP:

Email Address:

My resident school is:  

I am currently attending:

I am requesting attendance at:

Reason for transfer: Please be specific (I.E. employee, including location and position...): Max 1000 Characters

THE FOLLOWING MUST BE COMPLETED

Is student in Special Education Classes?  Yes    No              If yes, which program? RSP   SDC  

Is student receiving speech services? Yes    No        

Is student identified as Section 504?  Yes    No                                                       

Intradistrict transfers are granted upon space availability, review of the students conduct and discipline, punctuality, attendance and parental support of the school’s educational program. I understand that this transfer can be revoked at anytime if district standards of student conduct and discipline, punctuality, attendance, and parental support of the school’s educational program are not maintained or falsification of information is given, or for any other reasons as determined by district policy. I also understand that I must provide transportation to attend the school requested.

Signature (Please type your full name)                              Date: