DES MOINES PUBLIC SCHOOLS

Official Use Only

HE WITHIN-DISTRICT

HM

HH CONTINUATION APPLICATION

This application is a request to continue in your student’s current school. If you are not currently attending the school you are requesting, you will need to complete the within district transfer application.

Student Name: Date of Birth:

Gender: Male/Female Grade Level: Home Phone:

Home Address: Zip: Work Phone:

Parent Name: Alt. Phone:

School student is currently attending:

Reason for this application: ______

______

______

(Reason needs to indicate why your student is enrolled in the school if you do not currently reside in the attendance area)

Is this child currently enrolled in Special Education* ______Yes ______No

*If the student is in a special education program, approval is contingent upon available space in the receiving special education program as well as other open enrollment criteria.

My signature below indicates that all information is accurate and that I have read and understand the following:

• Approval is for this student only and does not guarantee approval of current or future siblings.

Requests for other siblings will be considered on an individual basis.

• Transportation for students approved for continuation is the sole responsibility of the parent.

The student and parent are responsible for the cost of any transportation services provided by the District.

• Approval is for the completion of the current school year only. If you desire for this approval to continue beyond the current school year, you will need to complete a within district transfer application for the following school year.

• Approval is contingent on the student being and remaining in good standing. (Good standing may include factors such as attendance, behavior, academic progress, etc.) Students exhibiting chronic problems in these areas may be denied or terminated from the program if deemed appropriate by the District Administration.

• Continuation may be terminated if it is determined that the approval was granted based on misleading information provided at the time of the application.

If your transfer is terminated for any reason, the student will be ineligible for transfer for one full academic year.

Signature of Parent/Guardian: Date: