Common use of Reason for Request Clause in Contracts

Reason for Request. The student’s financial, educational, safety, or health conditions would likely be improved. Attendance in the nonresident district is more accessible to the parent’s/guardian’s place of work or to the location of child care. There is a special hardship or detrimental condition. The purpose of the release is for enrollment in an online course or school program offered by an OSPI-approved provider. Parent/guardian is an employee with the requested school district. BEHAVIOR (attach sheet with explanation for any yes answers) Does the student have a record of conviction of crimes, violent or disruptive behavior or gang membership? Yes No Has this student been expelled or suspended for more than 10 consecutive days? Yes No Has the student repeatedly failed to comply with requirements for participation in an online school program, such as participating in weekly direct contact with the teacher or monthly progress evaluations? Yes No Has the student and/or parent had any formal meetings with school officials regarding school attendance issues in the past two years? Yes No Is this student under a court order to attend school or is a truancy petition in the process of being filed? Yes No EDUCATIONAL SERVICES REQUESTED Does this student qualify for Special Education services? (Must have an active IEP and a current evaluation) Yes No After completion of the placement test, does this student qualify for TBIP (Transitional Bilingual Instruction Program) services? Yes No Does this student qualify as Exited TBIP? (To qualify, the student was receiving TBIP services in the previous school year and/or current school year, and scored a Level 4 in the annual WELPA test in either the spring of those years.) Yes No COURSES REQUESTED (Include course or coursework description, credit, % of the day, etc.) Resident School Nonresident School Grades K-12                     Skill Center                     Running Start                     Please see third page for important notices, acknowledgements, and signature.

Reason for Request. The student’s financial, educational, safety, or health conditions would likely be improvedXxxxxx Unified School District Governing Board has established a priority list for the placement of students. Attendance in the nonresident district is Please xxxx any item that applies to your student (see attached AR 5117 for more accessible to the parent’sinformation): NEW INTERDISTRICT ATTENDANCE (XXX) REQUEST □ Parent/guardian’s place of work or to the location of child care. There is a special hardship or detrimental condition. The purpose Legal Guardian of the release student is for enrollment in Active Duty Military □ Parent/Legal Guardian of the student is an online course Employee of Xxxxxx USD □ Student requesting to attend the highest-grade level at their school (grades 6, 8 or 12) □ Sibling of a student currently attending a Xxxxxx USD school □ Other Requests: (Please feel free to attach additional information if needed) CONTINUING STUDENT □ Parent/Legal Guardian of the student is Active Duty Military □ Parent/Legal Guardian of the student is an Employee of Xxxxxx USD □ Student requesting to attend the highest-grade level at their school (grades 6, 8 or 12) □ Sibling of a student currently attending a Xxxxxx USD school □ Mid-Year: Recently moved out of Xxxxxx USD attendance boundaries and would like to complete the trimester (elementary), semester (secondary) or school program offered by an OSPIyear (Must apply as a new XXX for the following school year) FOR OFFICE USE ONLY Reason: New / Continuing ADM / TUSD Employee (Circle if Applicable) Proof of Employment Y / NA Report Card/Transcript Y / NA Release Y IEP/504 Y/NA Request Granted: Request Denied: Place on Wait List: Request Granted 18/19 only: Assigned School: Expiration Date: _ Notes: / / / / / / Director, Special Education Director, Student Services School Administrator STUDENT INFORMATION (for 2018-approved provider. Parent19): Student’s Legal Name: (as it appears on the Birth Certificate) Last First Middle Suffix Gender: □ M □ F Birth Date: / / Birth Date: / / Age:_____ Incoming Grade (2018-19): Most Recent School of Attendance: Name City State Sibling/guardian is an employee s: Name Age Grade Most Recent School Name Sibling/s: Name Age Grade Most Recent School Name PARENT / GUARDIAN INFORMATION: Please indicate with whom the requested school district. BEHAVIOR student lives: Primary contact number: Guardian / Father / Other Guardian / Mother / Other Name: Name: Address: Address: City: Zip: City: Zip: Home Phone: Home Phone: Cell Phone: Cell Phone: Work Phone: Work Phone: PLEASE ANSWER EACH OF THE FOLLOWING QUESTIONS ABOUT STUDENT: (if yes, answer when and where) Question No Yes When: Where: Previously attended TUSD Academic Performance Problems Attendance Problems Suspension(s) Expulsion(s) Grade Repeated Special Education-IEP / 504 (attach sheet with explanation for any yes answerscurrent copy) Does the student have a record of conviction of crimes, violent Alternative Education Program (Continuation School / County Day School / Opportunity Class) Participated in sport(s) against other schools or disruptive behavior or gang membership? Yes No Has this student been expelled or suspended for more than 10 consecutive days? Yes No Has the student repeatedly failed to comply with requirements for participation in an online school program, such as participating in weekly direct contact with the teacher or monthly progress evaluations? Yes No Has the student and/or parent had any formal meetings with school officials regarding school attendance issues in the past two years? Yes No Is this student under a court order to attend school or is a truancy petition in the process of being filed? Yes No EDUCATIONAL SERVICES REQUESTED Does this student qualify for Special Education services? (Must have an active IEP and a current evaluation) Yes No After completion of the placement test, does this student qualify for TBIP (Transitional Bilingual Instruction Program) services? Yes No Does this student qualify as Exited TBIP? (To qualify, the student was receiving TBIP services in extracurricular activities the previous school year and/or current AGREEMENT FOR INTERDISTRICT ATTENDANCE IN THE XXXXXX USD Student Name: I/We have applied for permission to attend a school year, and scored a Level 4 in the annual WELPA test Xxxxxx USD under the procedures set forth in either Education Code 46600-46610. If the spring of those yearsdistrict approves such a request, it will be approved under the following conditions. • Academics: Maintain satisfactory grades/credits at all times, during each grading period, remain on track to graduate on schedule. Deficiency in credits would be a reason to discontinue an XXX.) Yes No COURSES REQUESTED (Include course or coursework description, credit, % of the day, etc.) Resident School Nonresident School Grades K-12                     Skill Center                     Running Start                     Please see third page for important notices, acknowledgements, and signature.

Reason for Request. □ The student’s financial, educational, safety, or health conditions would likely be improved. □ Attendance in the nonresident district is more accessible to the parent’s/guardian’s place of work or to the location of child care. □ There is a special hardship or detrimental condition. □ The purpose of the release is for enrollment in an online course or school program offered by an OSPI-approved provider. □ Parent/guardian is an employee with the requested school district. BEHAVIOR (attach sheet with explanation for any yes answers) Does the student have a record of conviction of crimes, violent or disruptive behavior or gang membership? □ Yes □ No Has this student been expelled or suspended for more than 10 consecutive days? □ Yes □ No Has the student repeatedly failed to comply with requirements for participation in an online school program, such as participating in weekly direct contact with the teacher or monthly progress evaluations? □ Yes □ No Has the student and/or parent had any formal meetings with school officials regarding school attendance issues in the past two years? □ Yes □ No Is this student under a court order to attend school or is a truancy petition in the process of being filed? □ Yes □ No EDUCATIONAL SERVICES REQUESTED Does this student qualify for Special Education services? (Must have an active IEP and a current evaluation) □ Yes □ No After completion of the placement test, does this student qualify for TBIP (Transitional Bilingual Instruction Program) services? □ Yes □ No Does this student qualify as Exited TBIP? (To qualify, the student was receiving TBIP services in the previous school year and/or current school year, and scored a Level 4 in the annual WELPA test in either the spring of those years.) □ Yes □ No COURSES REQUESTED (Include course or coursework description, credit, % of the day, etc.) Resident School Nonresident School Grades K-12                     Skill Center                     Running Start                     Please see third page for important notices, acknowledgements, and signature.

Reason for Request. The student’s financial, educational, safety, or health conditions would likely be improvedXxxxxx Unified School District Governing Board has established a priority list for the placement of students. Attendance in the nonresident district is Please mark any item that applies to your student (see attached AR 5117 for more accessible to the parent’sinformation): NEW INTERDISTRICT ATTENDANCE (XXX) REQUEST □ Parent/guardian’s place of work or to the location of child care. There is a special hardship or detrimental condition. The purpose Legal Guardian of the release student is for enrollment in Active Duty Military □ Parent/Legal Guardian of the student is an online course Employee of Xxxxxx USD □ Student requesting to attend the highest grade level at their school (grades 6, 8 or 12) □ Sibling of a student currently attending a Xxxxxx USD school □ Other Requests: (Please feel free to attach additional information if needed) CONTINUING STUDENT □ Parent/Legal Guardian of the student is Active Duty Military □ Parent/Legal Guardian of the student is an Employee of Xxxxxx USD □ Student requesting to attend the highest grade level at their school (grades 6, 8 or 12) □ Sibling of a student currently attending a Xxxxxx USD school □ Mid-Year: Recently moved out of TUSD attendance boundaries and would like to complete the trimester (elementary), semester (secondary) or school program offered year (Must apply as a new XXX for the following school year) FOR OFFICE USE ONLY Reason: New / Continuing ADM / TUSD Employee (Circle if Applicable) Proof of Employment Y / NA Report Card/Transcript Y / NA Release Y IEP/504 Y/NA Request Granted: Request Denied: Place on Wait List: Request Granted 20-21 only: Assigned School: Transfer District: Expiration Date: _6 / 30 / Notes: / / / / / / Director, Special Education Director, Student Services School Administrator □ Parent Notified by an OSPIDate: / / □ Site Notified by Date: / / □ Aeries STUDENT INFORMATION (for 2020-approved provider. Parent21): Student’s Legal Name: (as it appears on the Birth Certificate) Last First Age: Middle Suffix Gender: □ M □ F Birth Date: / / Incoming Grade (2020-21): Most Recent School of Attendance: Name City State Sibling/guardian is an employee s: Name Age Grade Most Recent School Name Sibling/s: Name Age Grade Most Recent School Name PARENT / GUARDIAN INFORMATION: Please indicate with whom the requested school district. BEHAVIOR student lives: Primary contact number: Guardian / Father / Other Guardian / Mother / Other Name: Name: Address: Address: City: Zip: City: Zip: Home Phone: Home Phone: Cell Phone: Cell Phone: Work Phone: Work Phone: PLEASE ANSWER EACH OF THE FOLLOWING QUESTIONS ABOUT STUDENT: (if yes, answer when and where) Question No Yes When: Where: Previously attended TUSD Academic Performance Problems Attendance Problems Suspension(s) Expulsion(s) Grade Repeated Special Education-IEP / 504 (attach sheet with explanation for any yes answerscurrent copy) Does the student have a record of conviction of crimes, violent Alternative Education Program (Continuation School / County Day School / Opportunity Class) Participated in sport(s) against other schools or disruptive behavior or gang membership? Yes No Has this student been expelled or suspended for more than 10 consecutive days? Yes No Has the student repeatedly failed to comply with requirements for participation in an online school program, such as participating in weekly direct contact with the teacher or monthly progress evaluations? Yes No Has the student and/or parent had any formal meetings with school officials regarding school attendance issues in the past two years? Yes No Is this student under a court order to attend school or is a truancy petition in the process of being filed? Yes No EDUCATIONAL SERVICES REQUESTED Does this student qualify for Special Education services? (Must have an active IEP and a current evaluation) Yes No After completion of the placement test, does this student qualify for TBIP (Transitional Bilingual Instruction Program) services? Yes No Does this student qualify as Exited TBIP? (To qualify, the student was receiving TBIP services in extracurricular activities the previous school year and/or current AGREEMENT FOR INTERDISTRICT ATTENDANCE IN THE XXXXXX USD Student Name: I/We have applied for permission to attend a school year, and scored a Level 4 in the annual WELPA test Xxxxxx USD under the procedures set forth in either Education Code 46600-46610. If the spring district approves such a request, it will be approved under the following conditions:  Academics: Maintain satisfactory grades/credits at all times, during each grading period, remain on track to graduate on schedule. Deficiency in credits would be a reason to discontinue an XXX.  Attendance: Maintain a consistent pattern of attendance and punctuality as required by school district policy and individual school requirements, including those years.set forth in the student handbooks. Truancy or excessive absences or tardies would be a reason to discontinue an XXX.  Behavior: Follow all school district and individual school rules and class guidelines, including any set forth in student handbooks. Suspensions or an Expulsion would be a reason to discontinue an XXX.  Transportation: The parent/student will be responsible for providing her/his own transportation to and from school and must arrive at and depart from school according to the time schedules outlined by the school in their student handbook.  School of Attendance: The district reserves the right to transfer XXX students between schools if space is not available at a given site. I/We (Parent and Student) Yes No COURSES REQUESTED (Include course or coursework description, credit, % have read the above terms and conditions and agree that I/we are bound by them and are expected to meet all of the day, etcabove criteria. I/We understand that the permission of the student to attend school in Xxxxxx USD will be revoked for failure to meet the requirements set forth herein. I/We declare under penalty of perjury under the laws of the State of California that all of the information on this application is true and correct and I/we understand that any willfully inaccurate information provided in this application will be grounds for immediate denial or revocation of the Interdistrict Attendance Agreement. Name/Signature: (Parent / Guardian Name and Signature) Name/Signature: (Student’s Name and Signature) Date: / / Date: / / Note: Parent may sign for student but takes the responsibility of reviewing the contract with their child.) Resident School Nonresident School Grades K-12                     Skill Center                     Running Start                     Please see third page for important notices, acknowledgements, and signature.

Reason for Request. □ The student’s financial, educational, safety, or health conditions would likely be improved. □ Attendance in the nonresident district is more accessible to the parent’s/guardian’s place of work or to the location of child care. There is a special hardship or detrimental condition. The purpose of the release is for enrollment in an online course or school program offered by an OSPI-approved provider. Parent/guardian is an employee with the requested school district. BEHAVIOR (attach sheet with explanation for any yes answers) Does the student have a record of conviction of crimes, violent or disruptive behavior or gang membership? □ Yes □ No Has this student been expelled or suspended for more than 10 consecutive days? □ Yes □ No Has the student repeatedly failed to comply with requirements for participation in an online school program, such as participating in weekly direct contact with the teacher or monthly progress evaluations? □ Yes □ No Has the student and/or parent had any formal meetings with school officials regarding school attendance issues in the past two years? □ Yes □ No Is this student under a court order to attend school or is a truancy petition in the process of being filed? □ Yes □ No EDUCATIONAL SERVICES REQUESTED Does this student qualify for Special Education services? (Must have an active IEP and a current evaluation) □ Yes □ No After completion of the placement test, does this student qualify for TBIP (Transitional Bilingual Instruction Program) services? □ Yes □ No Does this student qualify as Exited TBIP? (To qualify, the student was receiving TBIP services in the previous school year and/or current school year, and scored a Level 4 in the annual WELPA test in either the spring of those years.) □ Yes □ No COURSES REQUESTED (Include course or coursework description, credit, % of the day, etc.) Resident School Nonresident School Grades K-12                     Skill Center                     Running Start                     Please see third page for important notices, acknowledgements, and signature.. OFFICE USE ONLY: Primary district whom is responsible for annual assessments and the portion of FTE each district is to claim for the student. Primary District FTE %