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Transfer Student Agreement - Loop ISD

By Patricia Hall,2014-02-07 23:53
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Transfer Student Agreement - Loop ISDISD,loop

    Loop Independent School District

    PO Box 917 Phone: (806) 487-6411

    Loop, Texas 79342 Fax: (806) 487-6416

District Student Transfer Application 2013-2014

    Transfer Application is: ___ New______ Renewal Transfer request for: _____ Current Year_______ Next Year Today’s Date________________________________________________

    Name of Student ___________________________________ Grade level: ____________ (2013-2014)

    Student’s Date of Birth: _______________________________ Gender: Male Female

    Student’s Social Security Number: ________-________-_______ Current age of student: _________

    With whom does the student live as a permanent resident?

    Both Parents Father Mother Other If Other, please explain: ___________________________________

    First Primary Guardian’s Name: _________________________________________________________________

    Address: ______________________________________________________________________________________ Work Place: ____________________________________________ Work Phone Number: ___________________ Home Phone Number: _______________________ Cell Phone Number: ____________________ Second Primary Guardian’s Name: _______________________________________________________________

    Address: ______________________________________________________________________________________ Work Place: ____________________________________________ Work Phone Number: ___________________ Home Phone Number: _____________________ Cell Phone Number: __________________________ School district where student resides: _________________________________________ School (campus) student attends (or would be attending) in that district: ______________________________ Name and Address of school student last attended: ________________________________________________ Was this student a transfer last year? Yes No If Yes, which District? _________________________________

    Has this student been assigned any disciplinary placement such as ISS, DAEP, or similar disciplinary placement in the last or current school year? Yes No (Returning Loop students may skip this question.) If Yes, please explain:

    ________________________________________________

    Give specific reason (in detail) why student is requesting a transfer out of the student’s current district:

    ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Is this student designated as any of the following: _______ ESL____Migrant____Special Education_____ 504

    Loop Independent School District

    PO Box 917 Phone: (806) 487-6411

    Loop, Texas 79342 Fax: (806) 487-6416

    I have been notified that my student does not reside within the boundaries of Loop Independent School District and must apply for a transfer in order to attend school in LISD. I am aware that the transfer may not be approved and my child must attend school in the district in which he or she resides. I understand that my student may be denied based on the effect of the student’s admission on the District’s compliance with special program

    requirements and restrictions, absences, failure of classes or TAKS, and/or disciplinary issues and that the transfer may be revoked for any of these same issues. I understand that my student must follow all school rules and school board policies.

    I certify all the information given is true and accurate to the best of my knowledge. If transfer is granted on false information, it is subject to revocation. Transfers must be renewed each year.

    Parent/Guardian Signature: Date:

    _________________________________________ ____________________________

    OFFICE USE ONLY:

    Dates of enrollment: _______________________ Absences: _______________

    Discipline referrals: ________________________________

    TPRI/STARR/EOC/TAKS:

    Reading: ______ met expectations______ did not meet expectations score: __________ Math: ________ met expectations______ did not meet expectations score: __________ This transfer is: _____ Granted____ Denied_____ Admission granted for a probationary period Reason for denial: ___________ No space available_______ Student does not meet guidelines Other: _________________________________________

    Administrator Signature: _______________________________________

    Date: _____________________

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