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Two Rock Un SD |  E  0520.2  Philosophy, Goals, Objectives and Comprehensive Plans

Title I Program Improvement Schools   

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PARENT/GUARDIAN TRANSFER REQUEST BASED ON

SCHOOL'S PROGRAM IMPROVEMENT STATUS

Instructions: To request a transfer for your child out of a school that has been identified for [program improvement, corrective action or restructuring], please complete the following form and return it by [date] to [the district office or to the Superintendent/Principal at your child's school]. You will be notified by [date] regarding your child's school assignment for the next school year and your options if you decide to decline the school assignment at that time.

Child's Name:

Parent/Guardian's Name: __________________________Signature:

School Child Currently Attends:

Please write numbers in the boxes below to rank your top [number] choices of available schools:

[ ] [school name]

[ ] [school name]

[ ] [school name]

If you have any questions, please contact the [district office or Superintendent/Principal] at [phone number].

Exhibit TWO ROCK UNION SCHOOL DISTRICT

version: June 18, 2009 Petaluma, California

___________________________________________________________________________

Exhibit 2

0520.2

TITLE I PROGRAM IMPROVEMENT SCHOOLS

PARENT/GUARDIAN SELECTION OF

SUPPLEMENTAL EDUCATIONAL SERVICES

Instructions: To select supplemental educational services for your child, please complete the following form and mail, fax, or deliver it to the Superintendent/Principal of your child's school or to the district office by [date].

Student's Name: ___________________________ School:

Parent/Guardian's Name: ____________________ Signature:

Please write numbers in the boxes below to indicate your top [number] choices of service providers:

[ ] [name of service provider]

[ ] [name of service provider]

[ ] [name of service provider]

[ ] [name of service provider]

Once a service provider has been determined for your child, the district will enter into a formal contract with the provider in accordance with law.

If you have any questions or need assistance selecting a provider, please contact [name] at [phone number].

Exhibit TWO ROCK UNION SCHOOL DISTRICT

version: June 18, 2009 Petaluma, California