For use with policies JECB-1
South Sanpete School District Application for Student to Attend School Out of School or District Boundaries Grade Requested (Please type of print clearly)
School Year Requested: _________________________________________
Grade Requested _______________________________________________
Fee __________________. Initial ______________________
School Requested _________________________________________
Home School____________________________________________
Grade ________________________
Application
1. Student ___________________________________________ Birthdate ___________ Age ________________
2. Students legal residence _____________________________________________________________________
Phone _________________ Male ____ Female ______________________
3. Father ______________________________________ Work Phone___________________________________
Mother______________________________________ Work Phone __________________________________
Legal Guardian _______________________________Work Phone __________________________________
4. Parent or Legal Guardian's Address ___________________________________________________________
5. Has the student ever been suspended or expelled from school? Yes ___ No ___
If yes please explain _________________________________________________________________________
2. Students legal residence _____________________________________________________________________
Phone _________________ Male ____ Female ______________________
3. Father ______________________________________ Work Phone___________________________________
Mother______________________________________ Work Phone __________________________________
Legal Guardian _______________________________Work Phone __________________________________
4. Parent or Legal Guardian's Address ___________________________________________________________
5. Has the student ever been suspended or expelled from school? Yes ___ No ___
If yes please explain _________________________________________________________________________
-___________________________________________________________________________________________
6. School grade level and/or program student is currently attending ___________________________________
7. District, school and specific program ( if any ) requested ___________________________________________
8. Prior enrollment in South Sanpete School District? Yes ___ No ___ Where? ___________________________
When? ______________________________________________________________________________________
9. Reason for request ____________________________________________________________________________
10. Special program and/or service _________________________________________________________________
A. What special services/IEP has the student received previously?__________________________________
B. What specific services/IEP is the student currently receiving? ____________________________________
C. Are there other programs or activities in which the student is participating? ________________________
6. School grade level and/or program student is currently attending ___________________________________
7. District, school and specific program ( if any ) requested ___________________________________________
8. Prior enrollment in South Sanpete School District? Yes ___ No ___ Where? ___________________________
When? ______________________________________________________________________________________
9. Reason for request ____________________________________________________________________________
10. Special program and/or service _________________________________________________________________
A. What special services/IEP has the student received previously?__________________________________
B. What specific services/IEP is the student currently receiving? ____________________________________
C. Are there other programs or activities in which the student is participating? ________________________
NOTE -- Any falsification or misrepresentation of the above information will result in cancellation of a transfer permit. Parent/guardian
is responsible for their own transportation to and from school except as provided in Utah Code 53A-2-210 and 53A-2-213(2)(b)
I hereby certify that the above information is true and correct to the best of my knowledge.
Dated this ________ day of _____________________ 20 ____
(parent or legal guardian's signature). _______________________________________________________________________________
ADMINISTRATIVE ACTION
ADMINISTRATIVE ACTION
1. Conference with Home Principal ________________________________________________ Date ____________________________
Approved -____________________________Rejected_________________________ Comments _____________________________
2. Conference with Receiving Principal_____________________________________________ Date ___________________________
Approved _____________________________Rejected __________________________Comments __________________________
Comments _____________________________________________________________________________________________________
The final decision for placement should be made in the best interest of the student provided
the decision does not inappropriately impact the home or the receiving schools.
the decision does not inappropriately impact the home or the receiving schools.
