Fillable KEENE ISD School Year 2021-2022 (Keene Independent School District)

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KEENE ISD School Year 2021-2022 (Keene Independent School District)

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For School District Office Use Only
As the authorized administrator of the district of desired attendance, I recommend the following action:
□ Approval to attend □ Disapproval
Signature_________________________________________ Date______________ Enrollment Date: _________
Reason for denial_____________________________________________________________________________
Revised (04/2021) Page 1 of 5
NEW
REAPPLY
COUNTY: ______________
DISTRICT: ______________
SCHOOL : ______________
KEENE ISD
School Year 2021-2022
Out of District Transfer Application for Non – Resident Student
(ONE APPLICATION PER CHILD)
The completion of this application is a request for out of district transfer only. Keene ISD will determine whether the
transfer request is granted; the request is not granted until the Superintendent’s signature appears on the Out of
District Student Transfer Agreement.
NOTICE: A person making a false statement in this document or any document for the purpose of school enrollment commits a
criminal offense under §37.10 of the Texas Penal Code and is subject to imprisonment or fine. Further, a person enrolling a child
under false documents violates §25.001 of the Texas Education Code and is subject to liability for tuition or costs under Texas
Law.
Students Full Name as appears on SS Card Social Security Number School Year Grade
Parent/Guardian (Father) _______________________________ (Mother) _________________________________
Address where Father resides: ______________________________________________________________________
Street City State Zip
Address where Mother resides: ______________________________________________________________________
Street City State Zip
Address where Student resides: ______________________________________________________________________
Street City State Zip
Father’s Phone Number: _________________________ Mother’s Phone Number: __________________________
Father’s E-mail Address: _______________________________ Mother’s E-mail Address: ____________________________
Current or Last School of Attendance: _________________________________________Grade: __________________________
DISTRICT OF RESIDENCE: ______________________________ SCHOOL NAME OF RESIDENCE: ___________________________
Check appropriate special program (if applicable):
□ Special program/class Program/Class_____________________________ (RSP, SDC, APE, S/L, OT, GATE)
□ Section 504 Accommodations
□ Currently suspended or expelled
I have read and understand the regulations and policies governing interdistrict attendance permits (on following pages) and
hereby submit my application. I declare under penalty of perjury that the information provided above is true and accurate. I
understand that this form will be subject to verification.
___________________________________________________
Printed Name (Parent/Guardian)
___________________________________________________ Date: _________________________________
Signature (Parent/Guardian
OFFICE USE ONLY
2021-2022
Page 2 of 5
Revised (04/2021)
****ALL THE FOLLOWING INFORMATION IS REQUIRED TO BE CONSIDERED A
COMPLETE TRANSFER APPLICATION****
ATTENDANCE INFORMATION: Please complete table below.
Number of Days the Student was Enrolled
Prior School Year
(Specify Year)
Current School Year
(Specify Year)
**STUDENT’S ACADEMIC RECORD OR TRANSCRIPT: PARENT IS RESPONSIBLE
FOR GATHERING THE REQUIRED DOCUMENTS LISTED BELOW. KEENE ISD IS
NOT OBLIGATED TO CALL PREVIOUS SCHOOL DISTRICT TO GET COPIES.
DELAY IN GETTING THESE DOCUMENTS WILL DELAY THE ACCEPTANCE
PROCESS AND SPACE IS LIMITED.**
REPORT CARD / TRANSCRIPT
DISCIPLINE RECORD
ATTENDANCE RECORD
STATE ASSESSMENT RESULTS (STAAR)
GENERAL INFORMATION: Please mark the appropriate response on each item below.
Is Student a child of a full time KISD employee?
NO
Was Student enrolled in KISD in the preceding year as a transfer student?
NO
Is Student a sibling of a previously approved transfer student?
NO
If yes, what is siblings name: ________________________________________KISD campus____________________
ATTENDANCE INFORMATION: Has the student experienced any of the following:
More than 5 absences in the current or preceding school year?
YES
NO
More than 5 tardies in the current or preceding school year?
YES
NO
Number of absences for the current school year
YES
NO
Number of absences for the preceding school year
If the student missed more than 10% of the days in the current or prior school year, please provide and explanation:
______________________________________________________________________________________________
______________________________________________________________________________________________
DISCIPLINE INFORMATION:
Has the student ever been suspended out of school, placed in DAEP, expelled, or placed in
JJAEP? If Yes, explain: ______________________________________________________
_________________________________________________________________________
YES
NO
Is the student currently on probation or other conditional release for a conviction of a criminal
offense? If yes, explain: _______________________________________________________
__________________________________________________________________________
YES
NO
Is the student on probation or other conditional release for delinquent conduct?
__________________________________________________________________________
__________________________________________________________________________
YES
NO
Has the student ever been assigned to In-School Suspension or suspended from campus? If
yes, explain: ________________________________________________________________
___________________________________________________________________________
YES
NO
Page 3 of 5
Revised (04/2021)
ACADEMIC RECORD:
Did the student pass all courses and get promoted to the next grade level?
YES
NO
Did the student pass all portions of the state assessments or meet all of IEP goals? (If no,
please list all portions not meeting state passing standard with scale score)
__________________________________________________________________________
__________________________________________________________________________
YES
NO
Is student on the A or AB Honor Roll?
YES
NO
Commended on any portion of the State Assessment?
YES
NO
Enrolled in Honors, Pre-AP, AP or Dual Credit courses?
YES
NO
Participate in any extra-curricular activity? (ex. Band, Choir, Art, FFA, FCCLA, UIL, Math
Pentathlon, Athletics, etc.) If yes, please list: _______________________________________
___________________________________________________________________________
YES
NO
UIL
In compliance with UIL requirements, students residing with parents outside of
district boundaries will not be eligible for VARSITY athletic competition for 1 year
from the date the student enrolled in KISD.
I certify that the discipline information above is true and correct to the best of my
knowledge.
_____________________________
Student Name
______________________________ ___________________
Parent Signature Date
Page 4 of 5
Revised (04/2021)
OUT OF DISTRICT TRANSFER AGREEMENT
Keene Independent School District
2021-2022
This Transfer Agreement establishes the terms and conditions for _______________________________
(“student”) to attend the Keene ISD (“district”) as a transfer student for the 2021-2022 school year.
The student is a resident of the ____________________________________Independent School District
The student’s parent or other person having lawful control of the student (“parent”):
NAME: _____________________________________________________________________________
DAYTIME PHONE NUMBER: ___________________________________________________________
EMAIL: _____________________________________________________________________________
Student’s parent or legal guardian requests that the student be permitted to attend Keene District schools
in the 2021-2022 school year and agrees to the following terms and conditions for that transfer:
1. This transfer is effective for the current school year only. District approval of this transfer creates
no right or expectation that the student will be admitted as a transfer for any subsequent year.
2. This transfer is approved for the named student only. District approval of this transfer creates no
right or expectation that another student from the same family will be admitted as a transfer.
3. The student must maintain acceptable levels of attendance, academic achievement, and
compliance with the Student Code of Conduct throughout the entire school year. Acceptable levels
are defined as:
a. Attendance that does not place the student at risk of losing credit under Education Code
25.092 or require that district to warn the parent or the student of truancy proceedings
under the Education Code 25.095:
b. Academic achievement that results in a passing grade in all courses by the end of the
semester. At the end of each grading period, the student should receive no more than one
grade that is below passing; and
c. Compliance with the Student Code of Conduct that results in no offenses requiring
removal to an Alternation Education Program or expulsion and no more than two referrals
each semester for other Code of Conduct infractions.
4. Parent(s) must comply with and observe all District policies and reasonable District and campus
procedures and requirements.
5. The superintendent may revoke the transfer of a student who fails to maintain an acceptable level
of attendance, academic achievement, or compliance with the Student Code of Conduct during a
semester or who fails to pay tuition on time.
6. The superintendent may revoke the transfer of student whose parent(s) do not comply with and
observe all District policies and reasonable District and campus procedures and requirements.
7. If this agreement is revoked, revocation ordinarily will be effective at the end of a semester;
however, the Superintendent has discretion to revoke the transfer at the end of a grading period in
which a standard for continued admission is violated. If this agreement is revoked for nonpayment
of tuition, revocation will be effective immediately. Policy FDA (LOCAL) explains the procedure for
Page 5 of 5
Revised (04/2021)
revocation.
8. The parent or the student will be responsible for transportation to and from the district school to
which the student is assigned
9. Except as modified by this Transfer Agreement, the student will be subject to all policies,
regulations, rights, privileges, and responsibilities of enrollment in the district as if he or she resided
in the district.
10. In compliance with UIL requirement, students residing with parents outside of district boundaries
will not be eligible for varsity athletic competition for 1 year form the date the student enrolled in
KISD.
The District and the parent agree that this transfer agreement is the entire agreement controlling the
admission and enrollment of the student in the District for the 2021-2022 school year.
Student Name: __________________________________________
Parent’s signature: _______________________________________
Date: ______________________
Principal’s signature: ______________________________________
Date: _____________________
Superintendent’s signature: _______________________________
Date: _____________________
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KEENE ISD School Year 2021-2022 (Keene Independent School District)

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Completed 31 July 2021

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