Form 1210-10 - Application For Transfer To An Alternative Elementary School Area
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1
2Prince Rupert School District No. 52
APPLICATION FOR TRANSFER TO AN ALTERNATIVE
ELEMENTARY SCHOOL AREA
RECEIVED AT BOARD OFFICE:
***To be submitted to School Board Office between
Date: ____________________
st
the 1
school day in February and the
last school day in February .***
Time: ____________________
PLEASE COMPLETE A SEPARATE FORM FOR EACH STUDENT
____________________________________________________
Date of Birth: _____ __________________________________
NAME OF STUDENT (please print)
For Transfer Effective/
School Year: _______________________________________
____________________________________________________
Address
Present Grade: ________
Grade in September: _________
____________________________________________________
Phone: ___________________________________________
Postal Code
_____________________________________________________________________________________________________________
NAME OF PARENT(S)/GUARDIAN(S)
(please print)
CATCHMENT AREA SCHOOL: ___________________________
DATE OF APPLICATION: ____ _________________________
CURRENT SCHOOL: ___________________________________
REQUESTED SCHOOL: ______________________________
Reason for Request:
academic programming, specifically
extra curricular programming, specifically
social/emotional, specifically
health/safety, specifically
other, specifically
(Please attach another page if more space is needed.)
I have read Policy 1210 and Regulation 1210-10 plus the Conditions on the reverse side of this form.
Signed:
_______________________________________
Parent/Guardian
Upon being signed by the parent/guardian, this application must be submitted to either the principal of the school
the student is currently attending or the School District Board Office.
The Parent or Guardian will be contacted by phone and/or letter with the cross boundary decision.
(If any special
conditions apply they will be stated below.)
approved
declined
Comments:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Superintendent or Designate: _______________________________________
Date: _______________________________
Form 1210-10
Revised: November 2013
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