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Kingsburg Elementary Charter |  E  5117  Students

Interdistrict Attendance   

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Exhibit 2



School Year ___________ New __ Renewal __

Currently Enrolled- Recently Moved Out of District __

Student Name ______________________________________ Date of Birth

Grade ________________________________

School District of Residence

Home/Cell Phone

Work Phone Parent/Guardian Name(s)



(P.O. Box # will not be accepted)

City State Zip

Is your child receiving Special Education Services? No ______Yes _____

Program(s): Speech ________ RSP ________ Special Day (SDC) ________

Other: 504 Plan English Learner

Has your child been expelled, recommended for expulsion, or potentially could be recommended for expulsion for acts committed in violation of California Education Code permitting expulsion? No ______Yes______

Explanation for requesting an Interdistrict Transfer

Criteria Regarding Interdistrict Transfer Requests and Enrollment:

Incomplete applications will not be processed. Requests will be considered based on local Board policies and individual merit.

Should the request be approved, I understand and agree:

* that the request will be valid for one year only and must be renewed annually;

* that I will notify the school of any changes regarding the information on this application;

* that I am willing to abide by the conditions of the Kingsburg Elementary Charter School District Charter;

* that KECSD may revoke the Interdistrict Transfer if my child fails to maintain appropriate behavior, attendance, or criteria based on the signed agreement on the reverse of this form;

* that my child's Interdistrict Transfer could be revoked if programs become impacted;

____(Initial) I have read and agree to the conditions listed on the reverse of this form.

I certify that all information provided in this application and any supporting documents are true and correct. Should my request for an Interdistrict Transfer be accepted by the Kingsburg Elementary Charter School District, I agree to the conditions listed on the reverse side of this document.

Parent/Guardian Signature Date

Office Use Only

Approved: ________ Denied: ________


Superintendent's Signature

Pursuant to the provisions of Board Policy 5117, if my child is granted the privilege to attend school in the Kingsburg Elementary Charter School District, I agree that my student will attend Kingsburg Elementary Charter School District only under the following conditions:

1) The student does not engage in any student misconduct, including, but not limited to, the violation of the law, school rule or school directives, whether or not such misconduct constitutes a violation of Education Code section 48900;

2) The student maintains a satisfactory record of attendance

* The attendance expectation at CVHS is 90%. Attendance is quantified by assignment completion as determined by the master teacher. A student is marked absent when they do not produce enough work for the learning period. Attendance under 90% may result in revocation of this Charter Agreement.

3) The student must maintain grades of "C" or better in all classes. "D", "F", "U", "Needs Improvement", "Incomplete" or "No Mark" are all considered to be unsatisfactory grades;

4) I understand and agree that it is my responsibility to ensure my child is working on assignments each and every school day. I also understand it is my responsibility to meet with the CVHS Master Teacher at least every 20 school days to ensure attendance as well as provide transportation for my child to and from classes, assessments, and any academic opportunity I wish for them to participate in.

5) Parent/Guardian agrees to the following:

* No violation of the Penal Code on or within 1,000 feet of school grounds

* No violation of the Vehicle Code on or within 1,000 feet of school grounds

* No threat to inflict physical harm directed at a pupil or staff

* No use of offensive words or engaging in a course of conduct likely to cause substantial emotion distress or provoke a violent response

Penal Code sections 415, 626.4, 626.6, 626.7, 626.8, 626.85

6) If parent or student violates any of the agreed upon conditions above, or the parent/guardian has been directed to leave school grounds, the following steps will be taken:

1. Written Warning

2. Hearing, as a result the following will occur:

a. Student/parent may be placed on a contract

b. Student/parent will be given 5 days to enroll in their district of residency or another charter school.

If a major student/parent violation occurs, as determined by the site administrator, an automatic hearing will take place. A hearing will take place immediately if a student has committed an expellable offense or been suspended for five total days.

7) I understand and agree that I provided certain information to the District to aid in its evaluation of my application for Interdistrict transfer and that I did so voluntarily after providing my express consent.

8) I understand and agree that I must renew my Interdistrict Transfer Request annually to be considered for enrollment in the following school year.

9) I understand and agree that the failure of me or my student to abide by and follow these conditions on a daily basis may result in the unilateral rescindment of the Attendance Agreement and the necessity of my child attending school in our district of residence.


version: March 9, 2020 Kingsburg, California