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2026-27 Roster Change
Complete this form for Interlocal transfers, building transfers and provider changes.  When the transfer is complete a notification will be sent to the email listed below.  It is the responsibility of the person listed as the email contact below to notify other team members of the transfer.
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Email *
Student's Last Name *
Student's First Name *
Student's Date of Birth *
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Which building in the county is the student transferring FROM? *
List the special education provider(s) for the student at his/her last school: *
Which building in the county is the student transferring TO? *
Name of the new Primary Provider *
List secondary provider(s) for the student at his/her new school: *
Does anyone else need access to the file (school psych, aux. users - Please enter names not positions):
Date of transfer: *
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