Get Fontana Unified School District Form

Fontana Unified School District FUSD School Districts of San Bernardino County Application for Interdistrict Attendance Permit Please print clearly. No fee for service 2. No excess costs 3. No transportation costs Denied Reason Child Welfare Attendance Special Services SELPA Authorized Signature Approved Title FONTANA UNIFIED SCHOOL DISTRICT CHILD WELFARE ATTENDANCE 9680 CITRUS AVENUE FONTANA CA 92335 909 357-7600 EXT. Complete one form for each student requesting a transfer. Student Name New Request School Year 20 Renewal Grade School of Residence School Currently Attending School Requested Parent/Guardian Name DOB Home Address Home Phone Cell Phone Is the student check yes/no City Zip Under expulsion order Yes No Sibling requesting transfer Special Education IEP 504-Plan Reason s for Request Childcare Continuing/Returning student District/Site employee To complete current year after moving to another attendance area Employment in the area Siblings attend district Open Enrollment Act Romero Bill SB5X-4 Pending change of residence this year attach copy of escrow or similar document within 90 days Health Reasons attach verification from licensed physician or clinical psychologist Other Childcare Person/Agency Employer Information Father Name Address Phone Signature of Childcare provider Terms and Conditions It is understood that the parent/guardian will have to provide home to school to home transportation* This permit is valid as long as the student s attendance behavior and academic performance are satisfactory to the district of attendance. False or misleading information may be cause for denial or revocation of a permit. Approval is subject to space availability in the district. A permit may be revoked for cause at any time. EC 46600 Failure to adhere to the above terms and conditions may result in revocation of this permit. I have read and understand the regulations and policies governing Interdistrict attendance permits and hereby submit my application* I declare under penalty of perjury that the information provided above is true and accurate. I understand that this form will be provided to the district of residence the district of desired attendance and that the information provided is subject to verification* Date FOR DISTRICT USE ONLY As the authorized administrator for the district of residence I recommend the following action check one Approved as long as there is 1. Complete one form for each student requesting a transfer. Student Name New Request School Year 20 Renewal Grade School of Residence School Currently Attending School Requested Parent/Guardian Name DOB Home Address Home Phone Cell Phone Is the student check yes/no City Zip Under expulsion order Yes No Sibling requesting transfer Special Education IEP 504-Plan Reason s for Request Childcare Continuing/Returning student District/Site employee To complete current year after moving to another attendance area Employment in the area Siblings attend district Open Enrollment Act Romero Bill SB5X-4 Pending change of residence this year attach copy of escrow or similar document within 90 days Health Reasons attach verification from licensed physician or clinical psychologist Other Childcare Person/Agency Employer Information Father Name Address Phone Signature of Childcare provider Terms and Conditions It is understood that the parent/guardian will have to provide home to school to home transportation* This permit is valid as long as the student s attendance behavior and academic performance are satisfactory to the district of attendance. False or misleading information may be cause for denial or revocation of a permit. Approval is subject to space availability in the district.