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Delano Joint HSD  |  E  5116.1  Students

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DELANO JOINT UNION HIGH SCHOOL DISTRICT

INTRA-DISTRICT ATTENDANCE REQUEST

This is to request an Intra-District Attendance Agreement beginning in the 20 ___ - 20 ___ School Year for:

Name: Grade: Date of Birth:

Parent(s)/Guardian(s) Name:

Address: Zip Code: Telephone:

Mailing Address (if different):

School of Residence: Requested School:

Parent(s)/Guardian(s) Statement of Reason for Request:

A condition of this transfer is that the parent agrees to provide transportation for their son or daughter. The district may revoke this transfer if the conditions under which it was granted cease to exist, or prove to be erroneously stated. Intradistrict transfers will be reviewed each semester for documented disciplinary infractions, determination of truancy pursuant to Education Code 48260, and/or academic progress. Transfers that do not meet the above criteria may be revoked. Students who are granted their first Intradistrict Transfer will be athletically ineligible for 30 days. A second Intradistrict Transfer would result in one year of athletic ineligibility. A third Intradistrict Transfer would result in indefinite athletic ineligibility. Any complaints or appeals shall be submitted in writing to the Superintendent or designee.

The conditions of this transfer have been discussed with me and I understand that the siblings of this student are not guaranteed attendance and must apply through the Open Enrollment process. I have received a copy of the Delano Joint Union High School District policy regarding transfers. I understand that if this transfer is approved my student will be athletically ineligible for at least 30 days. I declare under penalty of perjury that the above information is accurate to the best of my knowledge. I further acknowledge that attendance in a non-resident attendance area is a privilege and not a right.

FALSE STATEMENTS ON THIS FORM WILL RESULT IN IMMEDIATE REVOCATION OF THIS TRANSFER

Parent/Guardian Signature Date

(OFFICE USE ONLY)

___ APPROVED TRANSFER - (see athletic eligibility below)

___ Athletically Ineligible:

__ 30 days __ One Year __ Indefinitely __ Waived by Superintendent

___ TRANSFER DENIED

Transfer

__ approved __ denied

Signed by Principal of School of Residence Date

__ approved __ denied

Signed by Principal of School Requested Date

__ approved __ denied

Signed by District Superintendent Date

Exhibit DELANO JOINT UNION HIGH SCHOOL DISTRICT

adopted: February 5. 2013 Delano, California