(FORM AAC041)
                                                COUNTY DISTRICT NUMBER: 188-904
AUTHORITY FOR DATA COLLECTION: Texas Education Code 21.061; Civil Action 5281, Section A
PLANNED USE OF THE DATA: To complete the report required by Federal Court Order Civil Action 5281

BY SUBMITTING THIS FORM, YOU ACKNOWLEDGE THAT ALL ANSWERS PROVIDED IN RESPONSE TO THE TRANSFER APPLICATION ARE TRUE AND CORRECT. YOU UNDERSTAND THAT A PERSON MAKING A FALSE STATEMENT IN THIS APPLICATION OR ANY OTHER DOCUMENT FOR THE PURPOSE OF SCHOOL ENROLLMENT COMMITS A CRIMINAL OFFENSE UNDER SECTION 37:10 OF THE TEXAS PENAL CODE AND IS SUBJECT TO IMPRISONMENT OR FINE. FURTHER, A PERSON ENROLLING A CHILD UNDER FALSE DOCUMENTS VIOLATES SECTION 25.001 OF THE TEXAS EDUCATION CODE AND IS SUBJECT TO LIABILITY FOR TUITION OR COSTS UNDER TEXAS LAW. FOR FURTHER INFORMATION, CONTACT THE DIVISION OF EQUAL EDUCATION OPPORTUNITY AT (512) 463-9671.

PLEASE COMPLETE A SEPARATE FORM FOR EACH CAMPUS.  FOR INSTANCE, IF YOU HAVE A MIDDLE SCHOOL AND HIGH SCHOOL STUDENT YOU WILL NEED TO COMPLETE TWO FORMS.