Student School Transition Form

STUDENT SCHOOL TRANSITION FORM

This form documents the requested transition of a student between schools or programs and authorizes release and transfer of educational and health records necessary to effect placement and continuity of services. Complete all sections fully; incomplete or illegible submissions may delay enrollment or transfer.

Student Information

Date of Birth:    Student ID Number:    Current Grade / Program:

Current School Information

Receiving School / Placement

Anticipated Start Date at Receiving School:    Proposed Grade Placement:

Reason for Transition

Transfer within district Moving residence Parent/Guardian request Disciplinary transfer Special program placement

Academic and Support Status

IEP / Special Education 504 Plan ESL / ELL Services None of the above

Current GPA:    Credits Earned:    Last Report Card Attached: Yes

Health, Medical & Emergency Information

Is student taking medication at school? Yes No

Relationship:    Phone:

Transportation

Will student require district transportation? Yes No

Records Release Authorization

I hereby authorize the release and transfer of all educational and health records, including but not limited to transcripts, immunization records, special education records (IEP/504), diagnostic evaluations, discipline records, and attendance records, from the current school to the receiving school named herein. This authorization is necessary to ensure appropriate placement, service continuity, and compliance with applicable educational regulations.

Records to be released (select all that apply):
Transcript / Grades Health / Immunization IEP / 504 / Evaluation Discipline Records Other (specify below)

This authorization is effective upon signature and shall remain in effect until the receiving school confirms enrollment and record transfer is complete, unless an earlier date is specified below. Effective until:

Acknowledgments and Certifications

By signing below, I certify under penalty of perjury that I am the parent or legal guardian of the student named above, or the student is of legal age and is signing on their own behalf. I affirm that the information provided on this form is true and accurate to the best of my knowledge. I understand that false statements may subject me to administrative consequences under district policy.

I further acknowledge that transfer is subject to applicable district and state enrollment policies, residency verification, outstanding fees or obligations, and that additional documentation (proof of residency, custody documentation, health records) may be required by the receiving school.

For School Use Only

Enrollment Status:

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