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Sausalito Marin City SD |  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 SAUSALITO MARIN CITY SCHOOL DISTRICT

version: February 11, 2010 Sausalito, California

______________________________________________________________________________________

E(2) 0520.2

TITLE I PROGRAM IMPROVEMENT SCHOOLS

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: ________________________

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]__________________________

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 or need assistance selecting a provider, please contact [name] at [phone number].

Exhibit SAUSALITO MARIN CITY SCHOOL DISTRICT

version: February 11, 2010 Sausalito, California