P.O. Box 90010
Bellevue, WA 98009-9010
Choice Transfer Request
If student was NOT born in the U.S,
date first entered:_______________
Has your student ever received formal education outside of the United States? (K-12) yes no
If yes:
Number of months: ________ (1 year = 10 months) Language of instruction:_____________________
What date did your student first attend a school in the United States? (K-12) ________________
What language did your student first learn?
English OR
Other: _____________________
English OR Other: ____________________
What language does your student use the most at home?
What is the primary language spoken in the home, regardless of the language spoken by your child? ________________________
Student's place of birth: Birth City______________________ State ____________Country__________________
Last name_________________________________________First name ______________________________________ ____________________
#1 phone _____________
__________#2 phone ____________ ______________ email ___________________________________________
R
elationship
to Student
home cell work
home cell work
#1 Parent/guardian:
N
- No military affiliation
R- U.S. Armed Forces Reserves
A - Active duty U.S. Armed Forces G - Active duty Washington National Guard
Military Affiliation check one box:
Last name_________________________________________First name ______________________________________ ____________________
#1 phone _____________
__________#2 phone ____________ ______________ email ___________________________________________
R
elationship
to Student
home cell work
home cell work
#2 Parent/guardian:
Military Affiliation check one box:
N
- No military affiliation
R- U.S. Armed Forces Reserves
A - Active duty U.S. Armed Forces G - Active duty Washington National Guard
The transfer request is not complete until the resident school district has submitted the request to the nonresident school district, and it has
been accepted. The student remains the responsibility of the resident school district until the effective start date at the nonresident school.
The parent/guardian will be notified by email (or postal mail if an email is not provided) of acceptance and the effective start date or rejection.
If the request is rejected, the notification will include the reason for the denial and steps to appeal the decision.
If a district does not respond to a request within 45 days of the request, the request is treated as a denial and the parent/guardian can appeal.
Under the Choice law, the nonresident school district becomes responsible for all matters related to the education of the student (basic
education, special education, home/hospital services, truancy, CEDARS reporting, administration of state educational assessments, etc.). Legal
Reference: RCW 28A.225.220 through 230.
I certify that the information provided is accurate and complete.
I understand that approval of this request shall be dependent upon the acceptance and rejection standards stated in the
nonresident school district’s policy, and rescindment (revoking) of this transfer may occur in accordance to the conditions listed
in the nonresident school district’s policy.
I understand that my student must continue to attend the resident school until the effective start date of the transfer and that
nonattendance is subject to truancy procedures.
I understand that I will be responsible for providing transportation to and from school for my student, unless the nonresident
district is required to provide transportation for the student with a disability under Section 504 of the Rehabilitation Act of 1973
or the Individuals with Disabilities Education Act (IDEA).
I understand that requests are approved for one school year only, and it is my responsibility to complete a new form each year.
I understand that should my student move and no longer be a resident of the district, the transfer expires and I must submit a
new request to the new resident school district.
FERPA Release: I authorize the resident school district to release any and all of my student’s educational records to the Choice
Coordinator of the nonresident school district. By my signature I acknowledge that although I am not required to release my
student’s records, I am giving my consent to release the information. This release will remain in effect while my student is
enrolled unless I revoke such consent in writing. Note: Information will be provided in written format; no information will be
released over the phone.
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232(g); 34 CFR Part 99) is a Federal law that protects the privacy of student
education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.
FERPA gives parents certain rights with respect to their children’s education records. These rights transfer to the student when he or she
reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are “eligible students.”
Parents or eligible students have the right to inspect and review the student’s education records maintained by the school. Schools are not
required to provide copies of records unless, for reasons such as great distance, it is impossible for parents or eligible students to review the
records. Schools may charge a fee for copies. Generally, schools must have written permission from the parent or eligible student in order to
release any information from a student’s education record.
ACKNOWLEDGEMENTS
NOTICES
CHOICE TRANSFER REQUEST 2 of 4
Bellevue School District 1/15/2020
