Fillable REQUEST FOR STUDENT BOUNDARY WAIVER 3102F-5 Butte School (City of Oakland)

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REQUEST FOR STUDENT BOUNDARY WAIVER 3102F-5 Butte School (City of Oakland)

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3102F-5
REQUEST FOR STUDENT BOUNDARY WAIVER
Butte School District No. 1
Pleas
e note: It is necessary to complete one form for each child
DATE:
TIME:
Legal N
ame of Child:
Home
Address: Home Phone:
Home
School: Grade (as of last day attended)
Scho
ol Requesting Transfer TO: REASON:
Parent/Guardian Signature: Date:
…………
………………………………………………………………………………………………………………………………………………………………………………
*For Office Use Only*
ADMINISTRATIVE DECISION
Sending Principal Receiving Principal
Approved Approved
Denied D
enied
Reaso
n Reason
Signat
ure: Signature
Date Dat
e
…………
………………………………………………………………………………………………………………………………………………………………………………..
SUPER
INTENDENT DECISION Transfer Approved Transfer Denied
Supe
rintendent Signature:
Date:
Cc: Superintendent’s Office, Sending School and Receiving School
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REQUEST FOR STUDENT BOUNDARY WAIVER 3102F-5 Butte School (City of Oakland)

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Completed 11 February 2022

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