Exhibit

Student Services and School Attendance
1465 David E. Cook Way Clovis, CA 93611-0574 Phone: 559-327-9200 Fax: 559-327-9222

No. 2208 (1)

DIGMAC # __________

OPEN ENROLLMENT TRANSFER APPLICATION

Mailing label goes here. Please do not write in this area.

Completed applications must be returned to the Office of Student Services	and	School	Attendance or any comprehensive school.

PLEASE PRINT:

Today’s Date:	

Requested School Year:	

Student’s Full Legal Name:	

Male	Female	Date of Birth:	 CUSD Student ID#:	

Grade Requesting:	 Current School of Attendance:	

Requesting transfer from (school of residence)	 to (requested school)	

Parent/Guardian Name:	

Address:	 City:	 Zip:	

Home Phone:	 Work/Cell Phone:	 Email:	

SPECIAL EDUCATION: If applicable, please check the following services your student receives.

Resource Specialist (RSP)	Speech/Language	Hearing Impaired	Special Day Class (SDC)	Visually Impaired	504 Plan

Other (please describe)	

PARENT CERTIFICATION: I have read and understand all the transfer stipulations listed on the back and verify all the information provided is correct. I understand that if the information proves to be incorrect through error, omission or misstatement, my transfer application may be denied.

Signature of Parent/Guardian:	 Date:	

FOR DISTRICT USE ONLY	Date:__________________	FOR DISTRICT USE ONLY

WAITLISTED: There is no space available at this time. Your child has been placed on a randomized waiting list. Space availability will be monitored and you will be notified if space becomes available.

DENIED:

APPROVED: Your transfer has been approved for reason 	

to the following schools effective	through	

K-6

Intermediate

__ There is a documented safety concern (#2).
__ Special education Services are not available or impacted (#4).

High School

OP PE FA

Open Enrollment Parent Employment
Sibling Rule per Board Policy No. 5106

Appeal process is on the back

PARENT INFORMATION – ACCEPTANCE PROCESS

• In order to complete the open enrollment approval process, you must report to your school of choice with this form by 	 and sign an “Open Enrollment Acceptance of Transfer Approval” form. If you fail to sign the acceptance form by this date, the approval will automatically be rescinded.

• Please retain a copy of this application for your records. You may be asked to produce this form when your child moves to intermediate and/or high school.

• All the above mentioned conditions of transfer will apply once the transfer is accepted and the student is enrolled at their school of choice

Approval Date: _________________

FOR OFFICE USE

IF, AFTER YOU SIGN THE OPEN ENROLLMENT ACCEPTANCE OF TRANSFER APPROVAL FORM, AND YOU DECIDE FOR ANY REASON THAT YOU WISH FOR YOUR CHILD TO ATTEND SCHOOLS OTHER THAN THOSE LISTED ABOVE, YOU WILL NEED TO APPLY FOR ANOTHER TRANSFER.

CONTINUE APPLICATION ON BACKSIDE

CONDITIONS OF OPEN ENROLLMENT TRANSFER - PLEASE READ Please initial on the lines below

________Should transfer applications to attend a particular school exceed the capacity of that school; selection of students to enroll will be made through a random, unbiased process that prohibits an evaluation of whether any student should be enrolled based upon his or her academic or athletic performance. Children requiring special programs or classes will only be admitted to those schools offering such programs or classes on the basis of space availability. All students, including transfer students, are subject to capping and busing.

________In the case of boundary changes, approved transfers may require reapplication.

________Parents/guardians will be responsible for providing daily transportation to and from the school of choice.

________Intradistrict transfers are valid for one school year. For a transfer valid for more than one year, the parent/guardian must apply for an Open Enrollment Transfer between the first day of school and November 1 of the preceding school year. Once a transfer is accepted, the student may not return to his or her home school without applying for an additional transfer.

________According to Board Policy and Administrative Regulation No. 2505, students entering grades 7-12 who have accepted a transfer for the first time will be ineligible for athletic participation for one calendar year (365 days) from the date of first attendance within the District at the student’s new school. The 365 days of ineligibility may be appealed consistent with the requirements, standards and guidelines under Board Policy and Administrative Regulation No. 2505, which requires completion and submission of specific documentation. Again, authorization or approval by the District of an intradistrict transfer of students entering grades 7-12 does not result in the student obtaining eligibility for District interscholastic athletics. Please refer to Board Policy and Administrative Regulation No. 2505 regarding the limits to and requirements for obtaining athletic eligibility upon the granting of an intradistrict transfer. Athletes awaiting appeal decisions cannot participate in any athletic activity unless the parent/guardian has signed the “To Practice Release” form. If the athlete is deemed ineligible, the athlete is to stop practice and turn in his/her athletic gear.

If this transfer application is approved, student plans to file for an appeal for athletic eligibility (GRADES 7-12 ONLY): Yes No

My child requests eligibility according to the Sibling Rule (Board Policy No. 5106); I acknowledge that eligibility under the Sibling Rule is available only after a change to attendance boundaries.                                                                                                 Yes No

Older Sibling’s Name:	 Current Grade:	 Current School:	

PARENT INFORMATION – APPEAL PROCESS

You may appeal this decision within 30 days from the date above by submitting your appeal in writing to the Student Services and School Attendance Transfer Appeals Board. Letters are to be mailed to the address provided at the top of the form. You will be notified in writing of the results of your appeal.

Adopted: 12/12/07 Amended: 8/1/08 Reviewed: 7/8/09 Amended: 9/8/10 Revised: 11/16/11

Revised 2/23/12 Revised: 3/30/12 Revised: 5/16/13