In-District Transfer Request
Derby Unified School District #260
IN-DISTRICT TRANSFER REQUEST
Email address *
STUDENT INFORMATION
Student First Name *
Your answer
Student Last Name *
Your answer
Student's Date of Birth *
Your answer
Street Address *
Your answer
City State Zip *
Your answer
Parent Name *
Your answer
Parent Is An Employee of USD 260 *
Employee Position/Building
Your answer
Employed with Derby Public School since:
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
Email Address for Notification *
Your answer
Siblings Attending Derby with Grade Level
Your answer
Special Services Required or Receiving
Your answer
REQUEST
Home Attendance School *
School Assigned to Your Home Address
School Currently Attending *
What school is your child currently enrolled?
Requested Building *
1.
Requested Building *
2.
Requested Building *
3.
Years of COMPLETED Attendance in Requested Bldg. *
Your answer
Request is for Which School Year
Your answer
Expected Grade Level at Enrollment: *
Separate requests are required for each student.
The parent/guardian is responsible for transportation.
Transfer requests will be processed following district-wide enrollment on a time-stamped, first come first served basis.
Approval is contingent upon available space, appropriate school attendance, behavior, academic achievement, and parent/legal guardian support.
Transfer requests are valid for one school year, and therefore, must be made annually.
If approved, your child's placement must be accepted, confirmed and enrolled within 2 business days from the confirmation of approval notification.
Parent Signature *
By electronically signing this form, I am verifying that I am indeed the parent/legal guardian of this student, and I authorize Derby Public Schools to process this request as outlined within the form itself.
Your answer
Date *
Your answer
A copy of your responses will be emailed to the address you provided.
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