Santa Monica-Malibu Unified School District
Open Enrollment Act Transfer Application
Part I: Application Process
This application is for a student who:
A. attends a school on the Open Enrollment List as identified by the Superintendent of Public Instruction;
B. seeks to enroll in a Santa Monica-Malibu Unified School District school with a higher Academic Performance Index
(API) that the student’s current school of attendance.
Process:
1. Complete the Santa Monica-Malibu Unified School District (SMMUSD) Open Enrollment Act Transfer Application.
2. Sign the SMMUSD Open Enrollment Act Transfer Application verifying you have reviewed and understand the terms
and conditions for Open Enrollment Act transfers.
3. Submit the Transfer Application by April 30, 2014. Incomplete applications will not be processed. Do not fax the
application.
Submit to: Santa Monica-Malibu Unified School District
Student Services Department
1651 16th Street
Santa Monica, CA 90404
School Year: 2014 - 2015
Deadline: April 30, 2014
Part II: To be completed by parent/guardian (Please print)
Student Name (Last, First)
Birth Date
Gender:
School Requested
Grade Requested
Male
Female
Date of Request
My child will accept any SMMUSD school if the school
requested is not an option.
Yes
No
Current School of Attendance
Sibling attending school in SMMUSD?
Yes
No
Sibling applying to attend school in SMMUSD?
Yes
No
District of Residence
Parent/Guardian Name (Last, First)
Contact Number:
Home
Work
Cell
Email Address
Contact Number:
Home
Work
Cell
Address
City & Zip Code
Is the student currently pending disciplinary action or under
an expulsion order?
Yes
No
If the student is under an expulsion order, what is the
expulsion term end date? ____________________________
What special services has the student received? (Check all that apply and attach proof of enrollment in the special program.)
Gifted (GATE)
English Language Learner
Section 504
Special Education
If the student is receiving Special Education services, what is the student’s current placement? (Attach the IEP) Resource (RSP)
Special Day (SDC)
Non-Public School (NPS)
Academic Performance Index (API) of the current school of attendance: ________________
Pending Assessment
To identify the API, refer to:
www.cde.ca.gov.
Part III: Terms and Conditions
Open Enrollment Act transfers are subject to the terms and conditions stipulated in SMMUSD Board Policy 5118.
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Enrollment priority shall be available to students who reside within the district.
No student who resides within a school’s attendance area or who is currently enrolled in a school shall be displaced by a
student who is transferring pursuant to the Open Enrollment Act.
A students applying for an Open Enrollment Act transfer may only transfer to a school with a higher API than the
student’s current school of attendance.
The Open Enrollment Act Transfer Application shall be submitted between April 15th and April 30th of the preceding
school year for which the transfer is requested.
The Superintendent or designee may deny a transfer application under the circumstances detailed in BP 5118.
Students applying for open enrollment transfers shall be assigned priority for approval as detailed in BP 5118.
Approval is subject to enrollment, program and space availability.
The Special Education Department will review all applications for students with an Individualized Education Plan (IEP).
Approval is subject to program requirements and space availability.
The parent/guardian is responsible for providing transportation to and from school.
Parent Acknowledgement & Signature
I have read and understand the terms and conditions and understand the regulations and policies governing Open Enrollment
Act transfers and hereby submit my application. I declare under penalty of perjury that the information provided is true and
accurate. I understand the information provided is subject to verification and that the mere act of completing this application
does not guarantee this request will be approved.
Parent/Guardian Signature: __________________________________________ Relationship to Student: ________________
For Office Use Only
_____ yes
_____ no
The current school of attendance is on the Open Enrollment List as identified by the
Superintendent for Public Instruction. If no, the application is denied.
_____ yes
_____ no
The Academic Performance Index of the school requested is higher than the current
school of attendance. If no, the application is denied. The student may be offered an
alternative placement at a school with a higher Academic Performance Index.
Approval:
Administrator:
Approved
Denied
Dr. Mark O. Kelly
Director of Student Services
Placement: _________________________________________
Signature: _________________________________________
Date: _____________________________________________
Notes: _______________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Date and Time Received:
Received by: _______________________________________