In-District Transfer Request - Hillsboro School District Form
ADVERTISEMENT
1
2Hillsboro School District Form
IN-DISTRICT TRANSFER REQUEST
th
(Submit completed, original, signed form to your home school or to HSD Communications, 3083 NE 49
Place, #201, Hillsboro, OR 97124)
Date:
Student’s Legal Name (first, last):
Present Address (including apartment number):
City/Zip:
Phone:
Mailing Address (if different):
City/Zip:
Date of Birth:
School Year:
Grade:
Student ID Number:
Home School:
Requested School:
□
□
Student currently attends this school
Yes
No
□ I am requesting a Dual Language
□ I am requesting a STEM school transfer
□ I am requesting a K-8 school transfer
transfer
□
□
□
□
1.
IS STUDENT ON AN IEP?
Yes
No
2. DOES STUDENT RECEIVE/NEED EL SERVICES?
Yes
No
□
□
3.
IS STUDENT RECEIVING SPECIAL DISTRICT TRANSPORTATION?
Yes
No
If yes to questions 1 or 3, please forward request to the Executive Director of Special Programs.
Approved
Denied
Executive Director of Special Programs’ Signature
Date
PLEASE READ:
This form is to be used only by residents of the Hillsboro School District. Please attach a short letter outlining the reason for your request.
Transfer requests without an explanation may not be considered and may be returned to the parent or guardian.
It is the District’s intent that students attend school in the attendance area in which their parents or legal guardians reside.
Requests for in-district transfers will be reviewed using the criteria outlined in District policy JC/JECC-AR (rev. 12/14) and based upon space
available at the requested school. An excerpt of the policy listing transfer criteria and other provisions is provided on the reverse of this form
Keep in mind: 1) The District will not provide transportation for approved transfer requests unless otherwise indicated by the
Superintendent/designee. 2) Transfers are approved for one year only and are contingent upon the student meeting academic, attendance
and behavioral expectations. 3) Some options transfers are effective through the final year at the school, unless the parent/guardian moves
to a different attendance area.
Secondary Students Only: In competitive activities, governed by the Oregon School Activities Association (OSAA), eligibility will be
determined by a review based on OSAA standards. The District will not approve transfer requests based on athletic/activity considerations.
STATEMENT OF PARENT OR GUARDIAN
I affirm that I am the student’s custodial parent/legal guardian. I have read and understand the terms and conditions for a transfer
and I have attached a statement which clearly and fully explains why my student should be granted a change in school attendance.
If approved, I agree to assume all transportation needs of my student during the period of time covered by this request.
.
□
□
Signature ____________________________________________________
Parent
Guardian
Print Name ___________________________________________________
If request is related to child care, provide name, address and phone number of child care provider:
HOME SCHOOL:
RECEIVING SCHOOL:
□
□
□
□
Approved
Denied
__________________________
Approved
Denied
_________________________
Note
Note
_____________________________________
_____________
_____________________________________
_____________
Home Principal’s Signature
Date
Receiving Principal’s Signature
Date
□
□
□
Copy to:
Parent/Guardian
Home School
Receiving School
C001: In-District Transfer Request
Rev. 04/17/15
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Education