STUDENT TRANSFER VERIFICATION FORM

    Name of District: ____________________________________

    Name of School: ____________________________________

    CDS code: _______________________

    Date of Transfer: ___________________________________

    Name of Student: _____________________________ SID: ___________________________ Name of Parent(s)/Guardian(s):__________________________________

    Contact phone number: _______________________

    I. Parent or guardian must complete the following information about the student’s

    transfer and sign the form.

    My son/daughter ______________________________ is transferring to (name of school) _______________________________________ in the following town and state or country:_____________________________________________. I have checked the type of transfer on the list below and, where appropriate, I have provided the recommended documentation to the district.

    Signature: ______________________________ Print name: ___________________

    II. Parent/guardian must check the type of transfer on the list below.

    The district must keep this completed form with the required documentation

    attached on file as a student record that can be produced in an audit. Student

    transfers that are not documented must be counted as dropouts.

    Check the Type of Transfer:

    _____ (T 3) transfer to a nonpublic school within the state. Documentation is a written request for student records from the nonpublic school or a written acknowledgement of receipt of the records by the nonpublic school. Date the records are sent:________________________ _____ (T 4) transfer to any public school outside the district but within the state. Documentation is notation of the successful release of the SID to the receiving district. Date:_______________

    _____ (T 6) incarceration in a state or county entity with an educational program that leads to a

    regular high school diploma. Documentation is an official request for student records and notation of successful release of the SID to the institution, where applicable. Date:________________________

    _____ (T 7) transfer to a state or county institution for the treatment of a physical, mental, or emotional disability. Documentation is an official request for student records and notation of successful release of the SID to the institution, where applicable. Date:___________________

    _____ (T 8) transfer out of the state or country. Documentation of transfer to a school in another state requires a written response from an official in the receiving school or program acknowledging the student’s enrollment. Date:____________________________

    Documentation of transfers out of the country are verified by the parent/guardian’s signature above.

    _____ (T 9) Homeschooled.

    _____ (T C) transfer to a charter school. Documentation is notation of the successful release of the SID to the receiving charter school. Date:_______________________

    _____ (T D) transfer to a choice school. Documentation is notation of the successful release of the SID to the receiving choice district. Date:_______________________

    _____ (D 9) Deceased – The signature of the parent or guardian attesting that the student is deceased: Signature: _____________________________________________

FHS/transfer form 62910