Request for Classroom/Location Change
Student Information
Student Name:
Parent/Guardian Information:
Home Address:
Home Phone: Cell/Work/Other:
Current Site:
AM/PM/Full-Day (please circle one)
Current teacher:
Requested ½ day
AM/PM (please circle one)
Requests for specific teachers will not be
Requested FULL-Day Location (please choose from the following full-day sites):
Beattie Harris Irish Johnson Linton Lopez Putnam Rice
Community Sites: CSU (4 yrs. only) Teaching Tree Bright Horizons West The Family Center/La Familia
There may not currently be an opening where you have requested to change to; are you willing to keep your child at the
current location/teacher until an opening is available?
NO Why?
By marking no, you acknowledge understanding that your child will no longer attend preschool in their
current classroom and will be placed back on a waitlist for the requested classroom until a slot is
Reason for the request to move my child:
All requests will be recorded in the student’s record and kept on file. If the change can be made immediately you will be
notified by the ERSEA Department. If the change is not possible, the request will be kept on file and if an opening occurs
in the future you will be notified by the ERSEA Department.
I understand and agree to the previous statement regarding timeline, notification and understand that a request
does not guarantee a change of placement or location for my child.
Signature: Date:
Please return this form to:
Fullana Learning Center Main office: (970) 490-3204
220 N. Grant Ave. FAX: (970) 490-3134
Fort Collins, CO 80521
Revised 4/6/20
For office use only:
Child Plus#: Current Funding Source: TB/CPP/HS/ECSE
% of Poverty: Asset Score:
Requesting Change for School Year/s:
click to sign
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