Transfer Student Eligibility - Form B
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1GEORGIA HIGH SCHOOL ASSOCIATION
TRANSFER STUDENT ELIGIBILITY - FORM B
P. O. Box 271, Thomaston, GA 30286 - 706-647-7473 FAX: 706-647-2638
(Revised June, 2012)
INSTRUCTIONS: This form may NOT be handwritten, and must be submitted for each student who has transferred to your school in the past
twelve months from the date of the student transfer.
WARNING: Falsification of data on this form may result in institutional penalties such as fine and/or forfeitures of contests. It could result in
the student being declared ineligible for any competition for a period of up to two years. It also could result in the transmission of a report of the
falsification to the Professional Standards Commission if certified personnel were involved in the falsification.
DATE OF THE STUDENT TRANSFER__________________
ACTIVITY ___________________
SECTION A
SCHOOL ____________________________________________
CITY ___________________________ SCHOOL YEAR ____________
______ In-state Transfer ______ Out-of-state Transfer
______ Approved Foreign Exchange: Program _____________________________
(Complete Section A and B Only)
NAME
DATE STUDENT
(This Column for GHSA
DATE OF BIRTH
TH
ENTERED 9
GRADE
use only)
LAST
FIRST
MIDDLE
Mo.
Day
Year
Mo.
Day
Year
ELIGIBILITY STATUS
Beginning & Ending Dates Attended
th
Beginning with 9
Grade
(Give month, day, year)
Grade
Name of School
Address (City, State)
_____________________________
___________
______________________________________
________________________________________
_____________________________
____________
______________________________________
________________________________________
_____________________________
____________
______________________________________
________________________________________
_____________________________
____________
______________________________________
________________________________________
SECTION B - General Transfer Information
Present Home Address:__________________________________________________
____________________________________________
(Street)
(City, State)
(County)
Lives With: ___________________________________________________________
____________________________________________
(Names)
(Relationship)
Previous Home Address: _________________________________________________
____________________________________________
(
(Street)
City, State)
(County)
Persons Student Lived with at Previous Address: ______________________________
____________________________________________
(Names)
(Relationship)
Is the current residence located in your school service area? __________
Is the custodial parent a certified teacher, counselor or administrator at the receiving school (Grades 9-12)? __________
Was the student suspended or expelled (or facing such penalties) at the former school?
(If yes, attach additional information) __________
Does the student qualify for a waiver due to a joint custody or a custody change?
(If yes, attach court documents, including judge's signature) __________
SECTION C - Family and Residential Information (Complete only if a bona fide move is claimed)
CURRENT RESIDENCE:
Is the current residence being: ______ purchased; ______leased; ______rented?
Do you claim multiple residences? ______ If “Yes”, do you claim a Homestead Exemption on this residence? ______
PREVIOUS RESIDENCE:
Have you relinquished your previous residence? ______
If "Yes", how was it relinquished? ______ rented previously; ______sold residence or have a contract for sale; ______residence listed for sale at fair market
value; ______abandoned the house with unnecessary utilities shut off; ______leased/rented residence at a fair market value.
If “Yes”, is the residence being leased/rented to a family member? ______. If “Yes”, please list that individual and relationship:
__________________________________________________________________________________________________________.
VERIFICATION OF THE BONA FIDE MOVE: (Completed by school personnel)
______Accepted the word of the parent/guardian. ______Conducted a site visit - if "Yes", who made the visit ?_________________
______Received documentation via utility bill, post office documentation, driver's license, etc. - if "Yes", what document?________________
_________________________________________
___________________________________
____________________
(Signed - Principal / Asst. Principal / AD)
(Signed – Report Preparer)
(Date)
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