FOR OFFICE USE ONLY

SCHOOL: / GRADE AT ENTRY: / STUDENT ID #

Name of Student Gender Date of Birth

Date of Registration Date of Entry Date Bus Co. Contacted

School Transferring From Address/Phone/Fax of School

Date Records Requested Date Records Received

*REQUIRED REGISTRATION DOCUMENTS

*Locator Card *Registration Form

*Legal Birth Certificate/Adoption Decree/Passport Release of Confidential Information

*Immunization Records Bussing Form

State of RI Physical Form Dental Form

Kindergarten Bus Release *Legal Documents (Rec’d Y N Staff Initial__ ___)

Child Outreach Screening *Scanned to on _____

TRANSFERRING OUT

Last Day of Enrollment Consent to Release Information Rec’d Date Info Sent

CHARTER / HOME SCHOOL / OUT OF DISTRICT / PRIVATE

School Transferring To Address/Phone/Fax

Notification: Special Education Bus Company Technology Dept.

Please CIRCLE code below:

01 Xfer to Public Within Chariho
02 Xfer to Public Within State
03 Xfer to Public Out of State
04 Xfer to Private Non-Religious Within Chariho
05 Xfer to Private Non-Religious Within State
06 Xfer to Private Non-Religious Out of State
07 Xfer to Private Religious Within Chariho
08 Xfer to Private Religious Within State
09 Xfer to Private Religious Out of State
10 Xfer Out of Country / 11 Xfer to Institution
12 Xfer to Charter School
13 Xfer to Home Schooling
14 Matriculation to Another School
15 Graduated With Diploma
16 Completed With Other Credentials
17 Death
18 Illness
19 Expulsion
20 Reached Maximum Age / 21 Discontinued Schooling-Drop Out
22 Completed Grade 12-Did Not Pass Test
23 Xfer to GED Program
24 Xfer to Post-Secondary
25 Moved-Not Known to be Continuing
30 Matriculation to Next Grade
31 Retention to Current Grade
32 Completed GED Program
33 Changed District of Residence
34 Enrolled by IEP Max Age Requirement
Date of Change / Detail of Change / Staff Initial

Rev. 2017 ljbouchard