Form As-109 - Request For Student Transfer Within, Into Or Out Of Warren County Schools
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1WARREN COUNTY SCHOOLS
PO Box 110, Warrenton, NC 27589
Request for Student Transfer Within, Into or Out of Warren County Schools
Policy 4150 Parents or guardians wishing to transfer a child to a school outside their regular attendance area must make such request by
completing this and turning in to the Superintendent’s office by May 1 for the next school year. Only requests based on hardship situations and
space availability will be considered. The facts will be reviewed and a decision rendered by the Board of Education.
To be completed by Parent or Guardian (Proof of Legal Guardianship must be provided).
For School Year: ________________________
Student’s Name:_______________________________________________________________ DOB:_____________________ Age:_____
Parent’s Name:__________________________________________________________________ Telephone:________________________
County of Residence: _____________________________ Address:__________________________________________________________
City:____________________________________________ State: _________________________ Zip:______________________________
School/County currently assigned to: ________________________________________________________
Current Grade:____________
School to which you are requesting a transfer:_____________________________________________________________________________
13
Grade Level Requesting: (Please Circle)
Kdg. 1
2
3
4
5
6
7
8
9
10
11
12
Briefly, explain the reason for requesting this transfer.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
If request is based on the fact that you will soon be moving to a new location, please provide the following information concerning your new
residence:
County:_________________________________ Address:__________________________________________________________________
School which serves the district in which the new residence is located:__________________________________________________________________________
Warren County Board of Education:
Final approval of transfer request shall be dependent upon the availability of space and/or official release by any out-of-district Board of
Education. The Warren County Board of Education requires the parents of a student transferring into the Warren County School System
to pay a tuition fee for a non-resident student. This fee fluctuates based on local appropriation to the schools system; therefore, this fee is
adjusted on an annual basis. For the 2016-2017 school year, the fee for an out-of-district student is $2,077.00. This fee must be paid by the
parent on or before enrollment in Warren County Schools. The Board of Education waives tuition for out-of-district students who are
children of Warren County Schools' employees.
Parent/Guardian Signature:__________________________________________________Date:_________________________
Original: Submit To Superintendent’s Office
Copy: Parent
AS-109
Revised: 03/07/16
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