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Transfer Request Application 501.8-E

Student(s)
 First & Last NameGradeBoundary SchoolRequested School
Student 1
Student 2
Student 3
Student(s) Demographics
SexHispanicRaceDisability
FemaleMaleYesNoAsianBlack/African AmericanCaucasianNative AmericanPacific Islander2+ RacesYesNo
Student 1
Student 2
Student 3
I have read Board Policy 501.8 and Administrative Regulation 501.8. I understand that, if approved, this permit will expire, if not sooner revoked, upon my student’s completion of all grade levels at the requested attendance center, and my student will then be required to return to the next attendance center in the feeder boundary of my residence.
The following are the only Allowable Reasons for Transfer. You must check the one that is the basis for your request: *
I understand that if my child is in high school and transfers to another school within the District, my child will be ineligible to compete at the varsity level for 90 consecutive school days. This applies to ALL school activities, not just athletics.

Parents are responsible for providing transportation for students attending a school other than the school designated for attendance (boundary school). You may apply for paid bussing (based on existing route availability) by completing a Request for Transportation form available on the District website.
 
If my reason is for childcare or health reasons, my submission of this Form is authorization for the childcare provider or health care provider to release to the District such information about me and my child as the District may request in regard to this application and I agree to sign such additional authorizations as may be required by the provider.
 

NON-DISCRIMINATION STATEMENT: 

The Sioux City Community School District offers career and technical programs in the following areas: Business & Marketing, Family & Consumer Science, Health Science, and Industrial Arts, Technology, & PLTW. 

The Sioux City Community School District is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, genetic information (for employment), national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status (for employment) in its educational programs and its employment practices.  The District is required by Title IX and 34 CFR Part 106 not to discriminate on the basis of sex in its programs, activities, or employment.   

Inquiries or grievances under Section 504  and Title II of the Americans with Disabilities Act may be directed to Dr. Dora Jung, Director of Student Services & Equity Education/Title IX Coordinator at 627 4th Street, Sioux City, IA 51101, (712) 279-6075,  jungd@live.siouxcityschools.com. Inquiries about the application of Title IX and its regulations to the District may be referred to the Title IX Coordinator, the Assistant Secretary of the U.S. Department of Education, or both. Please see District Board policies 103 and 504.4 for additional information on available grievance procedures.