Teacher Change Request Form

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Teacher Change Request
Florida Statute 1003.3101 gives a parent the right to request his or her child be transferred to another classroom
teacher based on (1) the teacher’s out-of-field certification status or (2) personal preference. This statute does not
give the parent the right to choose a specific classroom teacher.
Student Name: _________________________
School ID: ____________________________ Grade Level: __________
Parent Name:
_________________________
Signature: _____________________________ Phone Number: ___________
Reason for Request (check one):
_______Teacher is out-of-field
_______ Personal Preference – Please explain in the space provided:
Conference Required – You will be contacted to schedule a conference.
Note - Consistent with school board rules and in accordance with state statute 101.28 (5) F.S., the Superintendent
has designated the principal of the school as the final authority in the placement of students in programs or classes.
For office use only:
Date request received _____________
Participants in the conference
___________________________ __________________________
___________________________ __________________________
Date of conference _______________
Principal approved __________________ Reassign student to ________________________________
Parent notified (date) _______________
Parent accepts/withdraws (circle one) the request.
Principal denies ____________
Reason _________________________________________________________
_________________________________________________________
_________________________________________________________
Parent notified of the decision (date)
__________________

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