PUSD Secondary School to School Transfer Request Form
Name
Student ID#
Address 1
Phone
Your email (a copy of this form will be sent to you)
Age (at the end of semester)
16
17
18
Date of Birth
CELDT data
Last school attended
Credits earned
Transfered FROM:
Adult Education
Ganesha
Garey
Park West
P.A.S.S.
Pomona
Diamond Ranch
Academy
Transfer TO:
Adult Education
Ganesha
Garey
Park West
P.A.S.S.
Pomona
Diamond Ranch
Academy
Voluntary status
Voluntary
Involuntary
Counselor recommendation
The following selections are counselor recommendations:
Regular day
Indepedant study
GED program
Teen parent
Work experience
Other
Other comments
Counselor's Signature/Date
Administrator Recommendation
Is there any gang affiliation - Probabtion Officer - Camp Returnee
Administrator signature/date
Special education (if applicable)
Special day class
RSP
Signed off
Program specialist signature/date
District transfer committee decision:
Grant
Deny
Chairperson signature/date
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