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