SAN LUIS OBISPO COUNTY
School Transfer Application
Open Enrollment Act (Ed. Code 48350-48361)
2017-18 School Year
Student Information
Student Name (Last, First, M.I.) – List only one student per application
Does the student have a current IEP? No___ Yes___
(If yes, please attach a copy)
Date of Birth
2017-18 Grade Level
Does the student have a current 504 Plan? No ___ Yes ___
Is the student an English Learner? No ___ Yes ___
Please note that providing this information is voluntary for data collection purposes, and that if provided, will not be a factor in the
admission decision.
Student Placement Notes:
Parent/Guardian Information
Parent/Guardian Name (Last, First, M.I.)
E-Mail Address
Parent/Guardian Address
Home Telephone
Work Telephone
Cell Telephone
School District Information
Check the Current School of Attendance (District of Residence)
Open Enrollment Schools List (Revised July 16, 2015)
Atascadero USD – Santa Rosa Road Academic Academy
Lucia Mar USD – Oceano Elementary
Lucia Mar USD – Grover Beach Elementary
Paso Robles JUSD – Georgia Brown Elementary School
Paso Robles JUSD – Virginia Peterson Elementary School
Requested School & District (District of Enrollment)
1) __________________________
2) __________________________
3) __________________________
San Luis Coastal USD – Baywood Elementary School
San Luis Coastal USD – Smith (C.L.) Elementary School
San Miguel JUESD – Lillian Larsen Elementary School
Shandon JUSD – Shandon Elementary School
Requested school of enrollment must have a higher Academic
Performance Index Score than current school of attendance.
For information on Academic Performance Index Scores, visit
http://www.cde.ca.gov/ta/ac/ap/
I understand and accept the following:
1. Transportation is to be provided by the family.
2. The requested district of enrollment will accept or deny this application based on local board policy.
3. Requests will be canceled if the student is not enrolled within 60 days of acceptance.
Signature of Parent/Guardian
Date
Parent: Return completed application to your current district of residence.
District of Residence
District of Enrollment
Date Application Received:
Date Application Received:
Following review of this application under the Open Enrollment Act
(Ed Code 48350-48361), and with due consideration for local board
policy, this application is hereby (check one):
Following review of this application under the Open Enrollment Act
(Ed Code 48350-48361), and with due consideration for local board
policy, this application is hereby (check one):
___
___
Approved
____ Denied
Approved
____ Denied
After action has been taken, a copy of the application will be sent to
the parent/guardian within five days, one copy sent to the district of
enrollment and one copy kept in the file of the district of residence.
After action has been taken, a copy of the application will be sent to
the parent/guardian within five days, one copy sent to the district of
residence and one copy kept in the file of the district of enrollment.
Verified by:
Verified by:
Date:
Date: