Madera Unified School District Open Enrollment Transfer Application 2021-2022 School Year

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Open Enrollment permits must be completed for each child for whom an open-enrollment transfer request is made. Applications to attend your school of choice must be submitted between March 1, 2021 through April 30, 2021 for the 2021-2022 school year.

The Open Enrollment application must be submitted online. For incoming kindergarteners please be certain you have registered your child at his/her school of residence.

If you have questions about which is your SCHOOL OF RESIDENCE, please call the Facilities Planning Department at 559-675-4548 or you may utilize the School Site Locator at www.madera.k12.ca.us.

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Student ID Number

Student's Date of Birth *

YYYY

Student's Last Name (Capitalize first letter of name) *

Student's First Name (Capitalize first letter of name) *

First Parent(s)'/Guardian(s)' Name (First and Last Name) *

Second Parent(s)'/Guardian(s)' Name (First and Last Name) or N/A

Phone Number of Primary Contact *

Area code-phone number (559-123-4567)

Email Address of Primary Contact

Street Address *

City *

Mailing Address Zip Code *

Student's Grade for 2021-2022 School Year: *

Student's Current School *

School of Residence (In what school's boundary does the student reside?) *

School of Desired Attendance *

Student's Special Education Program (If Any, Describe): *

Mark Reason(s) for Transfer Request (Check as Appropriate): *

Special circumstances exist which make it harmful or dangerous for the referenced student to attend school in the current attendance area. Attach one of the following: (a) A written statement from a representative of an appropriate state or local agency, including, but not limited to, a law enforcement official, social worker, or properly licensed or registered professional psychiatrist, psychologist, marriage, family child counselor, or (b) A court order, including a temporary restraining order and injunction issued by judge. Also, attach a written statement by the principal or vice principal of the school of the current attendance verifying that you have notified the school regarding the alleged harmful or dangerous conditions at the school. The District reserves the right to evaluate the legitimacy of any claims made under this enrollment priority.

The Student's parents/ guardians is requesting a transfer allowed through Professional Courtesy and employment is at the site requested.

The Student has been in attendance at the school of attendance during the year prior to the school year of proposed transfer, but will be required to attend another school pursuant to a boundary change, was there due to unintentional error and without deceit, and/or due to crowded (overflow) conditions at district of residence school.

The Student is currently enrolled and attending the desired school pursuant to a previously approved "Transfer Attendance Request."

Any sibling of the student is already in attendance in that school.

The Student's child care provider lives near the school requested K-8 (verification required)

The Student's parents/ guardians is requesting a transfer allowed through Professional Courtesy

Other (List siblings if you chose option 5)

其他：

必填

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