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SEMINOLE COUNTY PUBLIC SCHOOLS, FLORIDA OUT-OF-ZONE TRANSFER REQUEST K-12

THIS FORM MUST BE ACCURATELY COMPLETED WHEN MAKING A REQUEST FOR AN OUT-OF-ZONE TRANSFER.

THIS TRANSFER IS REQUESTED FOR SCHOOL YEAR

201_-201_

FOR OFFICE USE

STUDENT INFORMATION

STUDENT NAME: CURRENT SCHOOL: DATE OF BIRTH: _______________________ CURRENT GRADE: ______________________ Does your child have a current IEP for Exceptional Education? GENDER: Male Female Has your child ever attended Seminole County Public Schools?

ZONED SCHOOLS ES ___________ MS___________ HS ___________ Yes Yes No No

OUT-OF-ZONE TRANSFER INFORMATION

I am requesting an out-of-zone transfer from

(ZONED SCHOOL)

to

(REQUESTED SCHOOL)

for the ____________school year.

Full Time Site-based Employee -

THIS TRANSFER IS REQUESTED FOR THE FOLLOWING REASON:

Rising 5th, 8th, or 12th grader Pending Move

#___________

Capacity

Academic Year Completion

Other __________________________________________

Sibling of ESE student

Name of ESE student: Name of current student:

Current Grade: Current Grade:

Sibling of current student

PARENT/GUARDIAN INFORMATION I agree to the bulleted statements below. _______ (initial)

· · · · · · · If this transfer is approved for more than one semester, the student is required to remain at the requested school until the end of the current school year. Midyear exits are not permitted. I commit my support to the school and agree to participate in any parent/teacher conferences necessary to support my student's success. Transfers take effect during the first 5 days of school or for the first 5 days of second semester. Transfers are subject to class size availability. I acknowledge that no coach or any other person representing the school or athletic team to which the transfer is requested has made contact with the student/family prior to submitting this transfer. If you move you must notify the school. Please submit completed application to the student's zoned school or the Choices Department located in the Educational Support Center, 400 E. Lake Mary Blvd., Sanford, FL 32773.

I understand that a transfer may be revoked if attendance, tardiness, or behavior problems develop at the requested school. Approval of this transfer does not guarantee athletic eligibility (FHSAA 9.1.1). Florida Statute 837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree.

Parent/Guardian Name: ______________________________________ Signature: ______________________________________________

(Please Print)

Street Address: __________________________________________ Date: ________________

Apt. #:_______ City:

Zip:

Home Phone: ____________________________

Daytime Phone: ________________________________

FOR OFFICIAL USE ONLY

This transfer request

HAS BEEN DENIED

HAS BEEN APPROVED

CODE

SENDING SCHOOL

REQUESTED SCHOOL

This transfer is valid for: Transportation:

1st or

2nd Semester

Annual (one year only) Not Provided

Highest grade of approved school

Provided subject to available funding

_____________________________________________________________

SIGNATURE DATE

PURSUANT TO FLORIDA STATUTE 1003.03 REGARDING CLASS SIZE, THE STUDENT IS REQUIRED TO REGISTER AT THE APPROVED SCHOOL BY _________________________________ OR THIS TRANSFER IS INVALID.

If student is currently attending a Seminole County Public School, he/she must withdraw from the current school before enrolling at the requested school. PROOF OF RESIDENCY will be required for all students when enrolling at the requested school.

FOR ADDITIONAL INFORMATION CONTACT THE CHOICES DEPARTMENT: PHONE 407-320-0427 FAX 407-320-0105 www.seminoleschoolchoices.com

SCPS Form 1291 SB (Rev. 03/07/13)web

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