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KINGSBURG ELEMENTARY CHARTER SCHOOL DISTRICT

INTERDISTRICT TRANSFER REQUEST

Annual renewals must be submitted by February 1st for notification of approval/non-approval by June 30th. Mid-year requests must be submitted by the first of the month for consideration in that current month's Governing Board meeting. All requests must be approved by the Governing Board before enrollment of the student.

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) _____________________ Email __________________________

Address ___________________________________________________________________

(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 no later than February 1st;

* 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 class sizes or programs become impacted;

* that my child may go to the nearest bus stop and ride the bus to school. Schedules and information are available at the school sites;

____ (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, including timely attendance

* Which means that a student must be present 90% of the current school year.

* Attendance under 90% will be an automatic revocation of this Charter Agreement.

* Truancy per the California Education Code 48260 states that any child subject to compulsory continuation education who is absent from school without valid excuse three (3) full days in one school year or tardy or absent for more than any 30-minute period during the school day without a valid excuse on three (3) occasions in one school year, or any combination thereof, is a truant and shall be reported to the Kingsburg Elementary Charter School District Superintendent. Truancy is an automatic hearing referral that may result in the revocation of this charter agreement.

* Tardy is defined as the student not being in his/her assigned seat when the bell rings for the beginning of school and/or class period. Students who have seven (7) or more tardies will have their charter request revoked.

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 provide transportation for my child to and from school. I understand and agree that my child is to be picked up from school following dismissal from class no later than fifteen (15) minutes after dismissal unless under the direct supervision of a teacher for a specified reason (athletics, after school program, etc.).

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 by February 1st 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 Interdistrict Transfer and the necessity of my child attending school in our district of residence.

Exhibit KINGSBURG ELEMENTARY CHARTER SCHOOL DISTRICT

version: December 13, 2019 Kingsburg, California