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Student Services Department
Holly Shaffer, Director

INSTRUCTIONS FOR COMPLETING
Application for Non-Resident Admission

COMPLETE

Please be sure to fill in all blanks and check all appropriate boxes on this form. You may print this form out and complete it by hand, or you can type directly onto the form on your computer.

SIGN

Once the form is completed, please print out the form, and sign and date it.

OBTAIN RELEASE FROM RESIDENT SCHOOL DISTRICT

You will need to obtain a Release of Attendance form from your resident school district. Once you have that fully completed and signed form, please attach it to your Application for Non-Resident Admission.

TAKE TO SCHOOL

You will need to take both the Release of Attendance from your resident school district and your Application for Non-Resident Admission to the school you wish your student to attend, for their acceptance or denial.

FAX

You may also fax these forms to the school you wish your student to attend. Please call that school to obtain their fax number. Be sure to include your Release of Attendance from your resident school district.

EMAIL

We can only accept an emailed form with a signature attached. You may scan these forms after signing them, and email them to the school you wish your student to attend. Please contact that school to obtain their email address. Be sure to include your Release of Attendance from your resident school district.

The mission of Clover Park School District is to ensure each child learns what he or she needs to know to succeed and contribute to the community.


10903 Gravelly Lake Drive SW, Room 5 Lakewood WA 98499-1341 (253) 583-5154 Fax: (253) 583-5158 www.cloverpark.k12.wa.us

Clover Park School District

Application for Non-Resident Admission
(Separate forms must be completed for each student requesting admission)

Policy of the Clover Park School District established the following criteria as the basis for approving or denying transfers for non-resident students (policy 3131):

  1. Space available in grade level or classes;
  2. Appropriate educational programs or services available;
  3. Health/safety risk to other students or staff;
  4. Financial hardship to district;
  5. Educational records indicate a history of violent or disruptive behavior or gang membership; and
  6. Suspended or expelled more than 10 consecutive days from a public school.

Section I: Please Print Requested Information
(See instructions and important notes on reverse side)

1 Student Name: Birthdate
  Parent or adult student name Phone
2 Street address City Zip
3 Resident school district
4 Name of the school in Clover Park you want student to attend For grade
5 School year transfer is requested for
New request Renewal request
6 Briefly state the reasons for the transfer request:
7 Is this student currently enrolled in a special program
Yes No
(If yes, attach supporting materials as appropriate)
8 If yes, please check which program:
ECEAP/Head Start Special Programs ESL Alternative School Highly capable ROTC
9 Does your student have a history of violent or disruptive behavior or gang membership?
Yes No
10 Has your student been suspended or expelled for a total of 10 days or more from a public school within the past school year?
Yes No
I understand that I am responsible for providing transportation for my student at no cost to the Clover Park School District. I also understand that if my child becomes a discipline or attendance problem, the principal may revoke this transfer.
Transfer request is for one school year only. I hereby authorize the resident school district to release all educational records relating to the above-named student to the Clover Park School District.
11 Signature of Parent/Guardian   Date
Section II - School District User Only
12 Recommendation of special program administrator:
APPROVED DENIED
Policy criteria #
Signature: Date
12 Recommendation of receiving school principal:
APPROVED DENIED
Policy criteria #
Signature: Date
12 Decision of Student Services Administrator:
APPROVED DENIED
Policy criteria #
 
Signature: Date
If your transfer request has been denied, please see the back of this form for your appeal rights.
Fill out the form and click on the print button below

This form is used to Transfer a Student into the Clover Park School District

Transfer requests will be considered according to the following criteria:

  1. Space available in grade level or classes;
  2. Appropriate educational programs or services available;
  3. Health/safety risk to other students or staff;
  4. Financial hardship to district;
  5. Educational records indicate a history of violent or disruptive behavior or gang membership; and
  6. Suspended or expelled more than 10 consecutive days from a public school.

Please follow these steps:

  1. Obtain a release of attendance from your resident school district. We must have the release before we can process or approve your transfer into our district.
  2. Complete Section I completely (items 1 through 11) including the parent signature and date.
  3. Return this completed form and the release form from your resident district to the school you would like your child to attend or to the Student Services office.
  4. If your child is enrolled in a special program, the forms will be forwarded to the special program administrator for a status update. Then the forms will be sent to the receiving school.
  5. The principal will review your request, provide a recommendation to approve or deny the request and forward the forms to the Student Services office for a decision.
  6. Student Services will send you a copy of the completed form indicating the final action.

Note: If your request for transfer into the Clover Park School District is denied; you may appeal the decision. Please call 583-5154 and speak with the Student Services Director with your concerns or questions first. If your concerns are not resolved satisfactorily at the Student Services Office, you may appeal the denied transfer to the Superintendent of Public Instruction.

Please note: Athletic eligibility is governed by the rules of the Washington Interscholastic Athletic Association (WIAA).


Clover Park School District does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal, and provides equal access to the Boy Scouts and other designated youth groups. Address correspondence to one of the following individuals who have been designated to handle questions and complaints of alleged discrimination at Clover Park School District, 10903 Gravelly Lake Dr., SW, Lakewood, WA 98499-1341:
Title IX Coordinator Section 504/ADA Coordinator
Ron Banner, Deputy Superintendent
(253) 583-5051
Ron Banner, Deputy Superintendent
(253) 583-5051
Civil Rights Compliance Coordinator  
Lori McStay, Executive Director for Human Resources
(253) 583-5087