In-District Transfer Request
Derby Unified School District #260
IN-DISTRICT TRANSFER REQUEST

Application forms for In-District transfers and Out-of-District waiver requests will be available online only April 1, 2023 - September 1, 2023. Requests will be received, approved and placed on a time-stamped, first come first served basis, according to priority level and space availability. Your child should not enroll during regular enrollment online or at their school until placement is determined and you are notified. If approved, your child's placement must be accepted, confirmed and enrolled within in two business days from the confirmation of approval notification. Questions? Contact Christine Pitzer, cpitzer@usd260.com.

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Email *
STUDENT INFORMATION
Student First Name *
Student Last Name *
Student's Date of Birth *
Street Address *
City State Zip *
Parent Name *
Parent Is An Employee of USD 260 *
Employee Position/Building
Employed with Derby Public School since:
Home Phone *
Cell Phone *
Work Phone *
Email Address for Notification *
Siblings Attending Derby with Grade Level
Special Services Required or Receiving
Reason for Request
REQUEST
School Assigned to Home Address *
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. *
Request is for Which School Year  (ie 2023-2024)
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.
Application must be made annually. Each student will be evaluated annually.  Annual acceptance will not be granted if the student’s academic, attendance, and/or behavior record is not in good standing.
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.
Today's Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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