PROFESSIONAL COURTESY REQUEST FOR OUT-OF-ATTENDANCE ZONE PLACEMENT 2020-2021        
Please submit this form and send any supporting documentation to:  dbooker1@stamfordct.gov 

This request is for certified teachers only.

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Email *
Name of Student (Last, First) Please complete 1 form per student. *
Today's date *
Name of Parent/Guardian (Last, First) *
Street Address (Include # and Street ) *
Town *
Zip Code *
Home Phone # *
Cell Phone # *
Work/Other #
Email Address *
District School *
District School Grade *
Current School *
Current Grade *
Requested School *
Requested School Grade *
Parent Teaches At: *
Is this application a renewal request? (Child is currently attending school through OOAZ)   *
I understand and will abide by the following conditions for out-of-attendance zone placement for my child.   a. Out of attendance zone placement is in effect for one school year.  A new application must be submitted at the end of the school year for consideration to be given to extend the out-of-attendance zone placement.                                                                                 b. A student must maintain good attendance, satisfactory behavior, and acceptable academic progress.  A student’s record will be reviewed each marking period.  Failure to meet standards could result in a student being returned to the home school.            c. Parents/guardians will provide transportation for out-of-attendance zone placement.                                                                          Typing your name below will act as your signature. *
Please confirm that you completed the Out of Attendance. *
Please explain your request for Out-of-Attendance Zone placement for professional courtesy reasons below.   *
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