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 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 %

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.