Student Services Department

Holly Shaffer, Director

INSTRUCTIONS FOR COMPLETING

Request for Transfer Between Clover Park Schools

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.

TAKE TO SCHOOL

You will need to take this form to the school you wish your student to attend, for their acceptance or denial.

FAX

You may also fax this forms to the school you wish your student to attend. Please call that school to obtain their fax number.

EMAIL

We can only accept an emailed form with a signature attached. You may scan this form after signing it, and email it to the school you wish your student to attend. Please contact that school to obtain their email address.

Clover Park School District

Request for Transfer Between Clover Park Schools

Criteria for District Transfers — Policy 3131 of the Clover Park School District establishes the following criteria as the basis for approving transfers for students:

  1. Financial, educational, safety or health condition
  2. Child care, place of work
  3. Special hardship or detrimental condition

Section I — To be Completed by Parents (Please Print Requested Information)
(See instructions and important notes on reverse side)

1. Student name Birthdate
2. Parent or adult student name Phone
3. Street address City Zip
4. Resident school School requesting transfer to
5. School year for which transfer is requested For grade
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)
If yes, check one:
ECEAP/Head Start ECEAP/Head Start Highly Capable Special Education English as a Second Languagen

8. 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 has attendance or tardiness problems, the principal may revoke this transfer. Transfer request is for one year only. Signature below indicates agreement.

Signature of Parent/Guardian Date

Section II — School District Use Only

9. Administrator signature and status of program indicated in #7 (if applicable):

Space available
Program at capacity
Program not available

10. Recommendation of releasing school principal: APPROVED DENIED
Criteria

  1. Financial, educational, safety or health condition
  2. Child care, place of work
  3. Special hardship or detrimental condition
Principal’s Signature Date

Decision of receiving school principal: APPROVED DENIED

If approved, check one: Space available in grade level or program
Appropriate program or service available
If denied, check one: No available space in grade level or program
No appropriate program or service available
Health/safety risk to students or staff
Principal’s Signature Date

DISTRIBUTION: 1 COPY - Receiving School 1 COPY - Resident School ORIGINAL - Student Services 1 COPY - Parent

This form is used to transfer a student between schools within the Clover Park School District

Transfer requests are considered according to the following:

  1. Financial, educational, health or safety condition.
  2. Child care or place of work.
  3. Special hardship or detrimental condition

Parents are responsible for student transportation. Transfer requests must be renewed annually. The principal may revoke an approved transfer for problems associated with tardiness and attendance. A separate form is required for each student requesting a transfer. A separate form is required for each student requesting a transfer.

Instructions

This form should be completed at your resident school.

  1. Complete items 1 through 8. Sign and date the form and turn it in to the school office.
  2. If your child is in a special program as indicated in number 7, this form needs to be forwarded to that program administrator. The principal or secretary can forward the form for you or tell you the name and location of the program administrator. After the special program administrator has listed the status of the program, the form will be sent back to the releasing school principal.
  3. The releasing school principal will make his/her recommendation. The form will be forwarded to the receiving school principal. You may hand carry the request if you prefer.
  4. The receiving school principal will review your request and either approve or deny the student transfer.
  5. A copy of the completed form with the decisions will be given or mailed to you.

Note: If your request for a transfer is denied, please call 583-5154 and speak to the Student Services Director with any concerns.

Please note: Athletic eligibility is governed by Clover Park School District policy 3131 and procedure 3131-P2.

The Clover Park School District complies with all federal and state rules and regulations and does not discriminate on the basis of race, color, national origin, sex or disability. This holds true for all students who are interested in participating in educational programs and/or extracurricular school activities. Inquiries regarding compliance and/or grievance procedures may be directed to the school district’s Title IX/RCW 28A.260 compliance officer and Section 504/ADA coordinator: administrator for human resources, Clover Park School District, 10903 Gravelly Lake Drive SW, Lakewood, WA 98499, (253) 583-5080. Section 504/ADA coordinator: deputy superintendent, Clover Park School District, 10903 Gravelly Lake Drive SW, Lakewood, WA 98499, (253) 583-5050.