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LUCIA MAR UNIFIED SCHOOL DISTRICT INTERDISTRICT BOUNDARY AGREEMENT 2015-2016 Return to Curriculum Lucia Mar Unified School District 602 Orchard Street Arroyo Grande CA 93420 If you have questions please contact Curriculum and Instruction 805 474-3000 x 1120 I - Interdistrict Attendance Agreement Pursuant to Education Code Section 46600 Agreements are granted on a non-tuition transfer basis only. Date/Time Form Received This transfer is not based on employment or child care. PLEASE PRINT Part A Parent Request faxed or pdf copies are not accepted School of Residence /Lucia Mar Unified School District School Attended 2014-2015 GRAD E SPECIAL PROGRAMS DISTRICT and SCHOOL REQUESTED STUDENT S NAME RSP 504 PLAN SPECIAL EDUCATION CLASSES Father Mother Guardian Relationship Home Address Street address city zip code no p.o. LUCIA MAR UNIFIED SCHOOL DISTRICT INTERDISTRICT BOUNDARY AGREEMENT 2015-2016 Return to Curriculum Lucia Mar Unified School District 602 Orchard Street Arroyo Grande CA 93420 If you have questions please contact Curriculum and Instruction 805 474-3000 x 1120 I - Interdistrict Attendance Agreement Pursuant to Education Code Section 46600 Agreements are granted on a non-tuition transfer basis only. Date/Time Form Received This transfer is not based on employment or child care. PLEASE PRINT Part A Parent Request faxed or pdf copies are not accepted School of Residence /Lucia Mar Unified School District School Attended 2014-2015 GRAD E SPECIAL PROGRAMS DISTRICT and SCHOOL REQUESTED STUDENT S NAME RSP 504 PLAN SPECIAL EDUCATION CLASSES Father Mother Guardian Relationship Home Address Street address city zip code no p*o. boxes Mailing Address if different than residence address Telephone/home cell mother Father s Employer Name address phone Reason for Application Include any special needs your child may have including physical curricular or special education* Signature of Parent or Guardian Date IF DIVORCED WITH JOINT CUSTODY BOTH PARENTS MUST SIGN Part B Approval or Denial by District of Parent s Residence q The request for transfer is approved* District Designee/TransfersDate q The Governing Board or Superintendent s Designee of this district has approved your transfer request. Date/Time Form Received This transfer is not based on employment or child care. PLEASE PRINT Part A Parent Request faxed or pdf copies are not accepted School of Residence /Lucia Mar Unified School District School Attended 2014-2015 GRAD E SPECIAL PROGRAMS DISTRICT and SCHOOL REQUESTED STUDENT S NAME RSP 504 PLAN SPECIAL EDUCATION CLASSES Father Mother Guardian Relationship Home Address Street address city zip code no p*o. boxes Mailing Address if different than residence address Telephone/home cell mother Father s Employer Name address phone Reason for Application Include any special needs your child may have including physical curricular or special education* Signature of Parent or Guardian Date IF DIVORCED WITH JOINT CUSTODY BOTH PARENTS MUST SIGN Part B Approval or Denial by District of Parent s Residence q The request for transfer is approved* District Designee/TransfersDate q The Governing Board or Superintendent s Designee of this district has approved your transfer request.

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