Campus Transfer Request

Magnet School Application for Student Transfer

-Semester Transfers Only-



Male Female


Race: (Please answer questions 1 & 2)*

Hispanic or Latino Not Hispanic or Latino

Am. Indian Asian Black or African American Pacific Islander White



Parent/Guardian Name:*




Current School (or School Last Attended):*

Does this student receive services for Special Education?*


Yes No


If the answer is yes, in what setting?*


Resource Self‐Contained Other


Type of Transfer Request*


Child Care Hardship


Your transfer request will be approved or denied based on the information you provide on and with this application. Please answer the following questions thoroughly, and include any information that might have an impact on the decision

Are there childcare issues that impact this transfer request?

Yes No


If yes, please explain.

(Provide name, address and phone number of child care provider, if applicable)



Is your request to transfer related to a substantial hardship?

Yes No


(Please attach any documentation to the bottom of this application that supports your claim of hardship.)


If yes, please explain.


Please provide any additional information that may help us to understand further your request for a transfer.


(You may attach supporting information to the bottom of this application.)

Indicate here if attachments are included:

Yes No


If you are submitting this application after the January 8, 2014 deadline, please answerthe question below. "Late transfer applications will be considered only if extenuating circumstances exist. Such circumstancesinclude an unanticipated and significant change in the student'sstatus occurring after January 8 or other circumstances outside ofthe parent's/guardian's controlthat prevented themfrommeeting the application deadline. (Being unaware ofthe deadline is not considered an extenuating circumstance.)" Please describe your extenuating circumstances.

I hereby affirm that the information provided on and with this application is true and complete to the best of my knowledge. I understand that falsification or significant omissions may disqualify this application from further consideration or result in a revocation of an approved transfer. I further understand that any attendance, behavior, or academic problems may result in revocation of an approved transfer.

*If you are the guardian or legal custodian, please attach a copy of the court ordered custody agreement.


Signature of (Initial One):*


Security Measure