Choice Transfer Request Form - Kent School District - 2015
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2Kent School District
th
12033 SE 256
ST Kent, WA. 98030
New Request
Ph: 253-373-7235 Fax: 253-373-7127
Choice Transfer Request
Renewal
Requested District: ___________________________________________
School Year: 20___ to 20___
(one year only)
Requested School: ___________________________________________
Start Date: ___________
(if mid-year transfer)
Program:
_________________________________________
End Date: ___________
(if applicable)
STUDENT INFORMATION (one form per student)
Student:____________________________________________________
Birth Date: __________ Grade Level: _____
Legal name
First
Middle
Last
(of transfer year)
Parent/Guardian: ____________________________________________
Email: _______________________________
(Please print. Parent name required if student younger than 18 years of age)
Phone (1): _________________
Current or Last School Attended: ________________________________
Phone (2): _________________
Kent School District Boundary School: ____________________________
(Parent/Guardian contact if student younger than 18)
Residence Address
Mailing Address (if different from residence)
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________, WA ___________
_______________________________, WA ___________
City
Zip
City
Zip
REASON for REQUEST
The student’s financial, educational, safety, or health conditions would likely be improved.
Attendance in the nonresident district is more accessible to the parent’s/guardian’s place of work or to the location of child
care.
There is a special hardship or detrimental condition.
The purpose of the transfer is for enrollment in an online course or school program offered by an OSPI-approved provider.
Parent/guardian is an employee with the requested school district.
BEHAVIOR (attach sheet with explanation for any yes answers)
Yes No
Does the student have a record of conviction of crimes, violent or disruptive behavior or gang
membership?
Yes No
Has this student been expelled or suspended for more than 10 consecutive days?
Yes No
Has the student repeatedly failed to comply with requirements for participation in an online school
program, such as participating in weekly direct contact with the teacher or monthly progress
evaluations?
Yes No
Has the student and/or parent had any formal meetings with school officials regarding school
attendance issues in the past two years?
Yes No
Is this student under a court order to attend school or is a truancy petition in the process of being filed?
Please see second page for important notices, acknowledgements, and signature.
11/30/2015
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