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: arent/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:
