Attendance Area Change Request Form

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CAMPBELL COUNTY SCHOOL DISTRICT
ATTENDANCE AREA CHANGE REQUEST
The Campbell County Board of Trustees has established attendance areas for all students attending schools in Campbell County School
District.  There may be situations on an annual basis in which attendance area changes would be permissible.
When making an attendance area change request, the student's parent/guardian is to complete this form and submit 
it to the appropriate building administrator.  The building administrator will analyze the request and notify the 
parent/guardian of the decision regarding the attendance area change request.
SCHOOL YEAR: 
DATE:  _____________________________
2016-2017
___________________________________
STUDENT'S NAME:
________________________________________ ______
(Last)
(First)
(Initial)
___________________________________
PARENT/GUARDIAN:
________________________________________ ______
(Last)
(First)
(Initial)
ADDRESS:
__________________________________________________________________________________________
MAILING ADDRESS:
__________________________________________________________________________________________
(IF DIFFERENT THAN ABOVE)
PHONE #:  _______________________________________    CELL PHONE #:  ______________________________________________
___________________________________
RESIDE IN
ATTENDANCE AREA                                   GRADE:
______
(School Name)
REQUEST TO TRANSFER TO/REMAIN IN SCHOOL:   __________________________________________________________________
REASON FOR ATTENDANCE AREA CHANGE REQUEST:
   ___________________________________________________________________________________________________________
________________________________________________________
PARENT'S/GUARDIAN'S SIGNATURE
APPROVED:   ________
DENIED:          ________
__________________
________________________________________________
BUILDING ADMINISTRATOR'S SIGNATURE
                                    DATE
IF APPROVED:
IF DENIED:
This approval will allow your child to attend the requested school.
An approved request is in effect for the full school year, subject to any conditions set by 
the principal, including good attendance, behavior, work ethic, and positive parent 
interaction.
The District will not be responsible for transportation.

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