EFTA01248734.pdf

raj THE SCHOOL DISTRICT OF PALM BEACH COUNTY 45 36gslo, FCC? DEPARTMENT OF STUDENT SERVICES Student Reassignment ApplicationL9 ty 17 Submit this completed and signed form to the Department of Student Services, 3308 Forest Hill Boulevard, C-143, West Palm Beach, FL 33406-5869. School Transportation Is NOT PROVIDED by the Palm Beach District Schools to students who are granted reassignment Reassignment approval does not guarantee eligibility for athletic teams or other extraairricular activities. Contact your principal for information about eligizility. School reassignment is subject to change by Student Services during review. Student may be returned to the school in his/her assigned attendance area if: • he/she becomes a discipline and/or attendance problem. /00 • the student's parent or guardian Is unable or unwilling to work cooperatively with the policies and procedures of the reassired school, • the reasons for reassignment are no longer valid or the school's utilization exceeds 100%. This form Is not valid unless signed by parent or legal guardian. Student Reassignments will be reviewed annually. I an, I rmar, arm. I mar, Student Is requesting to be reassigned to (name of school) 120.---k k.--) /ft% el S,33 )/ What is the school attendance area in which the student now lives? 23 t v \ is3/ Does the student currently have a reassignment? 0 Yes 0 No What is the reason the student is requesting reassignment (choose an that apt* ❑ R 0Moving into Attendance Zone (enclose validproof) Supervision Hardship -Grades K-5 (Parent Employment Verification and Year Reassignment Supervision Hardship P850 0879 must be attached) ❑ Health Reasons** 0 Into County High hod Schedule Compatibility (Gummi year only) ❑rowialn tow) °The Student Reassignment Health &merlon form PBSI7 1893 must be completed by physician and attached. — State specific reason(s) why reassignment Is being requested to school listed above:, .phe eYTTe( cir -the school in gooLi -an we Wan? tier -to be in -The some schoo.4 QS nout.%l er. e live cicoc to -the ctiosoi .and we can ea i -ro,Kei All reassignment requests are measured against concurrency standards which were adopted by the School Board-Schools with enrollment above 100% of capacity can not be considered as a receiving school. If your reassignment request Is rejected for this reason, do you wish to have the Department of Student Se ' ;elect an available site? ❑ Yes 0 No • CU PAREN7 OR WON. GLL6 1Wl&AGfAILINt 05190y MR This not-valrd unless igned by parent glean guardian. DO NOT WRITE BELOW -STUDENT SERVICES USE ONLY U~OT APPROVED 0 VOID A! w SIXRECoDROR peso ow i t\ SW PBS° 0249 (Rev. 4/29/2003) ORIGINAL- Student Services COPY • Receiving School COPY- Sending S • COP - Parent 3501.218-013 CONFIDENTIAL Page 1 of 1 EFI'A_00074595 EFTA01248734