Out of BCSC District Transfer Form
REQUEST FOR STUDENT TRANSFER ENROLLMENT (for students living outside of the BCSC district)
Student First Name:
*
Student Last Name:
*
Birth Date:
*
-
Month
-
Day
Year
Date
Student Grade Level (for requested year):
*
Parent/Guardian First Name:
*
Parent/Guardian Last Name:
*
Home Address:
*
City, State, Zip Code:
*
Parent/Guardian Phone Number:
*
Format: (000) 000-0000.
Parent/Guardian Email Address:
*
example@example.com
Requested School(s): 1st Choice:
*
Please Select
Central
Clifty Creek
CSA Fodrea
CSA Lincoln
CSA New Tech
East
Johnson
McDowell
Mt. Healthy
North
Northside
Parkside
Richards
Rockcreek
Schmitt
Smith
Southside
Taylorsville
Requested School(s): 2nd Choice:
*
Please Select
Central
Clifty Creek
CSA Fodrea
CSA Lincoln
CSA New Tech
East
Johnson
McDowell
Mt. Healthy
North
Northside
Parkside
Richards
Rockcreek
Schmitt
Smith
Southside
Taylorsville
Has the student previously attended a BCSC School?
*
Yes
No
If yes, Dates Attended: From
-
Month
-
Day
Year
Date
To
-
Month
-
Day
Year
Date
Grades Attended:
Schools Attended:
Central
Clifty Creek
CSA Fodrea
CSA Lincoln
CSA New Tech
East
Johnson
McDowell
Mt. Healthy
North
Northside
Parkside
Richards
Rockcreek
Schmitt
Smith
Southside
Taylorsville
School student is transferring from:
*
School Corporation student is transferring from:
*
Reason for transfer request:
*
Disciplinary History
Has the student been expelled or excluded from school for 10 days or more in the past 12 months?
*
Yes
No
If yes, check the reason below:
Possession of a firearm, deadly weapon, or destructive device
Causing physical injury to another person
Violation of drug or alcohol policy
Chronic unexcused absences
Parent/Guardian Signature:
*
Date:
*
-
Month
-
Day
Year
Date
NOTE: Transportation is
not provided
for out-of-district transfer students.
Submit
Should be Empty: