Student Transfer Application Form printable pdf download

STAFFORD COUNTY PUBLIC SCHOOLS

STUDENT TRANSFER APPLICATION

INSTRUCTIONS: The parent or guardian must complete Part I, sign and submit the application to the requested school principal.

Applications must be received between March 7th and August 1st for the following school year. All necessary documentation

must accompany this request. Submit a separate form for each child. Student Transfers are granted on a space available basis.

Closed Schools: Margaret Brent, Moncure, Park Ridge, Rocky Run, Stafford, Widewater, and Winding Creek

Elementary Schools; A.G. Wright Middle School; and Colonial Forge and Stafford Senior High Schools are

CLOSED to transfers for the 2016-17 school year. Transfer requests to closed schools will be DENIED.

PART I

STUDENT TRANSFER REQUEST (please print)

Student Name: ______________________________________________________________________________________________

LAST

FIRST

For School Year: 2016-2017

Base School: _________________ Requested School: _________________ Grade Level: _____

Last School Attended: _________________ Date of Birth: _________________

Gender: Male

Female

Parent/Guardian Name: _____________________________________________

Home Phone: ____________________________

Address: _________________________________________________________

Other Phone: ____________________________

STREET

________________________________________________________

Email: __________________________________

CITY

STATE

ZIP CODE

REASON FOR REQUEST: (choose ONLY one)

Child Care ( for elementary and middle school students ONLY)– Attach Child Care Verification Form

Specific medical, emotional or adjustive needs – Attach professional documentation

Sequential (multi-year) curricular program – name of program: ___________________________________________________

Other valid need – Attach documentation detailing valid need

Does your student have an IEP?

Yes

I understand if the transfer is approved: 1) transportation is not provided by SCPS for students attending school on an approved transfer; 2)

per Policy 2103 transfers may be revoked due to attendance, discipline, or if the reason the transfer was approved is no longer valid (i.e. not

enrolling in a curricular program, changing daycare, etc) ; 3) the student must be a Stafford County resident; and 4) approval of this transfer

does NOT mean Virginia High School League (VHSL) eligibility is granted. A transfer student may not be eligible to participate in VHSL

sponsored activities per VHSL Transfer Rule 28-6-1. A student may lose eligibility if the student’s transfer is revoked or rescinded. Eligibility

is determined at the school into which you are transferring. (5) This transfer becomes void if not utilized by September 30

of the current

school year.

I certify that all the information on this application is correct to the best of my knowledge.

Parent/Guardian Signature: __________________________________________________

Date: _________________________

PART II

REQUESTED SCHOOL USE ONLY

Requested School: ____________________

Approved:

Pending Special Ed.

Denied:

Does not meet criteria

Final

Capacity

Comments: ________________________________________________________________________________________________

Principal’s Signature: _________________________________________________________

Date: ________________________

After Part II is complete, send form and any attachments to the Student Transfer Office.

PART III

SPECIAL EDUCATION/ ADMINISTRATIVE RECOMMENDATION (office use only)

Approve

Deny

Comments: ____________________________________________________________________________

Signature: __________________________________________________________________

Date: _________________________

PART IV

CENTRAL OFFICE USE ONLY

Date Reviewed: __________________ Received By: _____________________ Code: _____________

Appeal: Approved

Denied

Comments: ____________________________________________________________________

Signature: __________________________________________________________________

Date: ________________________

Student Transfer Office, Reference: Policy 2103 and Regulation 2103-R, Student Transfers

Revised 1/7/2016

Student Transfer Application Form

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