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San Mateo Un HSD |  E  0520.2  Philosophy, Goals, Objectives and Comprehensive Plans

Title I Program Improvement Schools   

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PARENT/GUARDIAN TRANSFER REQUEST BASED ON SCHOOL'S PROGRAM IMPROVEMENT STATUS

Instructions: To request a transfer for your child out of a school that has been identified for [program improvement, corrective action or restructuring], please complete the following form and return it by [date] to [the district office or to the principal at your child's school]. You will be notified by [date] regarding your child's school assignment for the next school year and your options if you decide to decline the school assignment at that time.

Child's Name: ______________________________________________________________

Parent/Guardian's Name: __________________________Signature: ___________________

School Child Currently Attends: ________________________________________________Please write numbers in the boxes below to rank your top [number] choices of available schools:

[ ] __________________________[school name]__________________________

[ ] __________________________[school name]__________________________

[ ] __________________________[school name]__________________________

If you have any questions, please contact the [district office or principal] at [phone number].

Exhibit SAN MATEO UNION HIGH SCHOOL DISTRICT

version: July 15, 2010 San Mateo, California

_______________________________________________________________________________PARENTAL NOTIFICATION: SUPPLEMENTAL EDUCATIONAL SERVICES

Dear Parent/Guardian:

The ___________________ School is subject to the accountability requirements of the federal No Child Left Behind Act of 2001 for schools receiving Title I funds that fail to make "adequate yearly progress," as defined by the State Board of Education, toward meeting the state's student academic achievement standards. In accordance with those requirements, eligible students in the ____________________ School may receive supplemental educational services (such as tutoring and other supplemental academic enrichment services outside the regular school day) by a provider with a demonstrated record of effectiveness. The district has determined that your child is eligible based on family income.

You are entitled to select supplementary educational services for your child from a list of service providers approved by the State Board of Education. Approved providers that are within the district, are reasonably available in neighboring local educational agencies or are available through technology are listed below. A brief description of the services, qualifications and demonstrated effectiveness of each such provider is enclosed.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Please submit your top [number] choices of service providers on the enclosed form by [date] to [the district office or the principal at your child's school]. It cannot be guaranteed that your first choice will be available. If funding is insufficient to serve all eligible students, or if a particular service provider is unable to serve all students who select that provider, priority will be given to the lowest achieving eligible students in the district.

If you wish assistance in choosing a provider or have any questions about this program, contact [ name ] at [ phone number ].

Exhibit SAN MATEO UNION HIGH SCHOOL DISTRICT

version: July 15, 2010 San Mateo, California

_______________________________________________________________________________PARENT/GUARDIAN SELECTION OF SUPPLEMENTAL EDUCATIONAL SERVICES

Instructions: To select supplemental educational services for your child, please complete the following form and mail, fax or deliver it to the principal of your child's school or to the district office by [date].

Student's Name: ___________________________ School: ___________________________

Parent/Guardian's Name: ____________________ Signature: ________________________

Note: Districts should insert the name of each available service provider in the spaces below and add or delete spaces depending on the number of available providers.

Please write numbers in the boxes below to indicate your top [number] choices of service providers:

__ _______________________[name of service provider]__________________________

__ _______________________[name of service provider]__________________________

__ _______________________[name of service provider]__________________________

__ _______________________[name of service provider]__________________________

__ _______________________[name of service provider]__________________________

Once a service provider has been determined for your child, the district will enter into a formal contract with the provider in accordance with law.

If you have any questions, please contact [name] at [phone number].

Exhibit SAN MATEO UNION HIGH SCHOOL DISTRICT

version: July 15, 2010 San Mateo, California