MSD Elementary Schools Intra-District Transfer Request

MSD Elementary Schools Intra-District Transfer Request

Medford School District 549c - Medford, OR
School year the request is for*
Student grade level in requested year*
Student Name*

First NameMiddle NameLast Name
Student Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*
Email (for notification of transfer status)*
example@example.com
Parent/Guardian Home/Cell Phone*
Please enter a valid phone number.
Parent/Guardian Work Phone
Please enter a valid phone number.
Current Address*

Street Address

Apt Number

CityState

Zip Code

Read and initial below that you understand and agree to the following conditions:
1. Parents / Guardians must provide transportation to and from school within the school schedule.
2. Approval of any request for one student in the family does not automatically carry over to other students.
3. Attendance and punctuality will be reviewed at the end of each quarter. If attendance drops below 90%, the transfer may be revoked.
4. Should the student's behavior become unacceptable, the transfer may be revoked.
5. False and/or misleading statements regarding this request will result in denial or revocation of the transfer.
6. Proof of residency may be required at any time.
I understand this transfer is only valid for the individual student's elementary school career and is contingent upon acceptable levels of attendance, academic progress and behavioral standards. Failure to adhere to these standards may result in revocation of the transfer.
Signature

Clear
Initial if you agree initial* Date Date*
Should be Empty: