Form Isbe 33-78 - Student Transfer Form printable pdf download

ILLINOIS STATE BOARD OF EDUCATION

Accountability and Quality Assurance Center

Quality Assurance and Improvement Planning Division, E-310

100 North First Street

Springfield, Illinois 62777-001

STUDENT TRANSFER FORM

In accordance with Section 2-3.13a of the School Code, all public school districts are to provide this form to any student who

is moving out of the district to verify whether or not the student is “in Good Standing” and, whether or not their medical

records are up-to-date and complete as defined in Section 2-3.13a. “In Good Standing” means that the student is not being

disciplined by an out-of-school suspension or expulsion, and is entitled to attend classes, as of the date of this form. No

public school district is required to admit a new student unless they can produce this form from the student’s previous Illinois

public school district.

NAME OF STUDENT (Last, First, Middle)

BIRTHDATE (Month, Day, Year)

SEX

GRADE LEVEL

ADDRESS OF STUDENT

NAME OF PARENT OR GUARDIAN

PARENT/GUARDIAN TELEPHONE

Home

Work

ADDRESS OF PARENT OR GUARDIAN

Please check (√) the appropriate box.

I hereby attest that the above student is “In Good Standing” and that all medical records for

the above student are up-to-date and complete as of the date of this form.

The above student’s medical records are not up-to-date and complete as documented in the

student’s permanent records.

I hereby attest that the above student is not “In Good Standing” due to a current suspension

and/or expulsion; but is entitled to transfer in accordance with Section 2-3.13a (105 ILCS 5/2-

3.13a).

I hereby attest that the above student is not “In Good Standing” due to a current suspension

and/or expulsion from ___________________________ until _________________________

And is not eligible for transfer for knowingly possessing in a school building or on school

grounds a weapon as defined in the Gun Free Schools Act (20 U.S.C. 8921 et seq.); for

knowingly possessing, selling, or delivering in a school building or on school grounds a

controlled substance or cannabis; or for battering a staff member of the school.

NAME OF PRINCIPAL

SCHOOL PHONE

COUNTY

DISTRICT NAME

DISTRICT ADDRESS (City, State, Zip Code)

_______________________

___________________________________________

Date

Signature of Principal

ISBE 33-78 (9/96)

Form Isbe 33-78 - Student Transfer Form

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