Notice of Change of Residence for Student Enrolled at an NPS

Page | 1Exhibit P

Notice of Change of Residence for student enrolled at an NPS

Date of Fax to new District:
Name ofNew District of Residence:
District Special Education Director or Coordinator Fax:
Name of District Special Education Director or Coordinator:
District Special Education Director or Coordinator Phone: / Parents call this phone number to coordinate the registration of your child in your new district.
Instructions to new district: Within 5 days of receipt of this notice please coordinate with parent the registration of the following student in your district.
Student Name: / Grade: / Date of Birth:
Student Street Address:
Student City: / State: CA / Zip:
Parent Name: / Date family moved to new address:
Parent Home Phone: / Parent Cell Phone:
NPS School of Enrollment:

Parent Signature:
Instructions to parent: Within 5 days, please contact the New District of Residence Special Education Director at the telephone number noted aboveto coordinatethe registration of your child in your new district of residence or your child can be subject to possible dis-enrollment at this NPS.
Date of Fax to Former District:
Name ofFormer District of Residence:
Name of Former District Special Education Director or Coordinator:
Former District Special Education Director or Coordinator Phone:
Former District Special Education Director or Coordinator Fax:
Instructions to Former District: Within 5 days please contact the new district of residence noted at the top of this page and coordinate the transfer of student records to the new district of residence.

Instructions to NPS:

• Confirm student’s new district of residence at
• Provide a copy of Page 1 of this completed form Exhibit P to parent with New District of Residence contact information.
• Fax this completed form Page 1 & 2 to New District of Residence within 3 days of notice of pupil’s change of residency.
• Fax Transportation change to New District of Residence.
• Fax this completed form Page 1 to Former District of Residence within 3 days of notice of pupil’s change in residency.

Notice of Change of Residence for student enrolled at an NPS

Date of Fax to new District:
Name ofNew District of Residence:
District Special Education Director or Coordinator Fax:
Name of District Special Education Director or Coordinator:
Student Name: / Grade: / Date of Birth:
NPS School of Enrollment:

When a parent indicates they have relocated or request a transportation location pickup or drop off change the NPS and LEA are to proceed as follows:

Non Public School Duties

1)NPS completes Exhibit P and obtains Parent signature with new address and the date family moved to new address.

2)NPS - Confirm student’s new district of residence at

3)NPS provides a copy of Exhibit P page 1 to parent with New District of Residence contact information.

4)NPS - Fax Page 1 & 2 to New District of Residence Special Education Director/Coordinator within 3 days.

5)NPS - Fax Transportation change to New District of ResidenceSpecial Education Director/Coordinator.

6)NPS - Fax Page 1 to Former District of Residence Special Education Director/Coordinator within 3 days.

7)NPS monitors parent returned copy of New District registration within 5 days and retains for records.

8)Beginning the 6th day, at the NPS discretion, the NPS may notice parent of disenrollment either because parent has not registered the student in the New District of Residence (LEA) or the New District of Residence (LEA) has not developed an ISA with the NPS.

9)NPS - Fax or email to New District of Residence the notice of student disenrollment on the first day of disenrollment.

10)Upon receipt of ISA, NPS shall submit monthly payment demand to New District of Residence beginning with the effective date of parent enrollment document. NPS shall attacha copy of parent registration form to payment demand.

Note to NPS: Per Sonoma SELPA Master Contract Section P (3) The ISA shall terminate for any pupil upon the termination of the pupil’s residency within LEA’s boundaries.

LEA Duties as New District of Residence

1)Upon receipt of this notice, LEA shall contact parent to coordinate school registration.

2)LEA contacts Transportation Agency to confirm transportation change.

3)LEA tracts parent registration and reviews IEP.

4)Within 5 days of this notice, LEA shall submit a new ISA to NPS or convene an IEP meeting to discuss placement and make a new offer of FAPE.

5)Upon receipt of invoice from NPS, LEA shall make payments according to Master Contract Section Q(7) guidelines.