ILLINOIS STATE BOARD OF EDUCATION
Educator and School Development Division
100 North First Street, E-310
Springeld, Illinois 62777-0001
STUDENT TRANSFER FORM
STUDENT IDENTIFICATION NUMBER
(9-digits)
In accordance with Section 2-3.13a of the School Code, all public school districts are to provide this form to any student who is moving
out of the school district to verify whether or not the student is “in good standing” and, whether or not their medical records are up-to-
date and complete as dened in Section 2-3.13a. “In good standing” means that the student is not being disciplined by an out-of-school
suspension or expulsion, and is entitled to attend classes, as of the date of this form. No public school district is required to admit a new
student unless they can produce this form from the student’s previous Illinois public school district. This form is not to be returned to
the Illinois State Board of Education. It is to be sent directly to the student’s new school they will be attending.
NAME OF STUDENT (Last, First, Middle) BIRTHDATE (Month, Day, Year) GENDER GRADE LEVEL
Male
Female
ADDRESS OF STUDENT (Street, City, State, Zip Code)
NAME OF PARENT OR GUARDIAN PARENT/GUARDIAN TELEPHONE (Include Area Code)
Home Work
ADDRESS OF PARENT OR GUARDIAN
DISTRICT NAME AND NUMBER TRANSFERRING TO NEW DISTRICT ADDRESS (City, State, Zip Code)
NAME OF SCHOOL STUDENT WILL BE TRANSFERRING TO NAME OF PRINCIPAL AT NEW SCHOOL
Please check () the appropriate box.
I hereby attest that the above student is “in good standing” and that all medical records for the above student are up-to-date
and complete as of the date of this form.
The above student’s medical records are not up-to-date and complete as documented in the student’s permanent
records.
I hereby attest that the above student is not “in good standing” due to a current suspension and/or expulsion
from _______________________________________ until _______________________________________; but is entitled
to transfer in accordance with Section 2-3.13a (105 ILCS 5/2-3.13a), unless the receiving district has, pursuant to Section
2-3.13a, adopted a policy providing that if a student is suspended or expelled for any reason from any public or private school
in this or any other state, the student must complete the entire term of the suspension or expulsion before being admitted into
the school district. This policy may allow placement of the student in an alternative school program established under Article
13A of this Code, if available, for the remainder of the suspension or expulsion.
I hereby attest that the above student is not “in good standing” due to a current suspension and/or expulsion
from _______________________________________ until _______________________________________ and is not eligible
for transfer for knowingly possessing in a school building or on school grounds a weapon as dened in the Gun Free Schools
Act (20 U.S.C. 8921 et seq.); for knowingly possessing, selling, or delivering in a school building or on school grounds a con-
trolled substance or cannabis; or for battering a staff member of the school.
NAME OF PRINCIPAL SCHOOL PHONE COUNTY
DISTRICT NAME AND NUMBER DISTRICT ADDRESS (City, State, Zip Code)
_________________________ _____________________________________
Date Signature of Principal
ISBE 33-78 (3/09) THIS FORM IS TO BE SENT DIRECTLY TO THE STUDENT’S NEW SCHOOL THEY WILL BE ATTENDING.
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