MSAD 52 Agreement Form

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Use this form for notification for Superintendent Requests and In District Transfers

Email *

Which type of agreement are you applying for? *

Superintendent Agreement

In District Transfer

Is this request for the current school year, or next year? *

This Year

Next Year

Student's Name: *

Student's Address: *

Please give full street address, city, state, and zip code

Parent's Name and Contact Information: *

Grade Attending *

This should be the grade level the student will be entering if this is approved

Requesting Permission to: *

Enter MSAD 52 (remember you need to submit your request in your residing district before MSAD 52 will make a decision)

Transfer from MSAD 52 to another district

Transfer from another school in MSAD 52

Renewal (remember you need to submit your request in your residing district before MSAD 52 will make a decision)

Does the student have a 504?

Yes

Clear selection

Does the student have an IEP?

Yes

Clear selection

Requesting to Attend: *

Please list other school attending in Other if you are requesting to leave MSAD 52

Turner Primary School

Turner Elementary School

Greene Central School

Leeds Central School

Tripp Middle School

Leavitt Area High School

Other

Reason for Request *

Please give a detailed explanation for the request

Will you be making any additional requests for siblings?

Please list the sibling names and schools you will be requesting. This does not replace making the additional request, this is to provide administrators information so they can consult when making their decisions.

Administrator Section

Only to be filled out by building administrator

Do you approve of this request

Yes

Clear selection

Provide details for your selection

Superintendent Section

Only the superintendent should fill out this section

Is this request supported

Yes

Clear selection

Reasons for making this decision

Submit

Clear form

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