Public School Attendance Verification
EMAIL: apply@arizonaleader.org
FAX: (855) 340-9399
Required for students who are transferring from an Arizona public or charter school
If your child is transferring from an Arizona public or charter school you must submit this form completed by an
ocial
at the child’s prior Arizona public or charter school. Your application is incomplete without this form.
APPLICANT INFORMATION
Student’s Name:__________________________________________________________________________________
Parent’s Name:___________________________________________________________________________________
Address:________________________________________________________________________________________
________________________________________________________________________________________
PUBLIC or CHARTER SCHOOL VERIFICATION
Public or Charter School aended: ___________________________________________________________________
Public or Charter School address:_____________________________________________________________________
Phone #:__________________________________
The following informaon must be completed by a public or charter school ocial.
DATES OF ATTENDANCE
The student MUST have attended a minimum of 90 school days or one full semester of the 2019/20 school
year to qualify for this scholarship as a public or charter school transfer student.
First day of the 2019/20 school year:_____/_____/_____
Student’s date of admission:_____/_____/_____ Student’s date of withdrawal:_____/______/______
Name of Public or Charter school official verifying this Information (Please Print)
________________________________________________
Signature:________________________________________Date:___________________________
Title:____________________________
