INTRADISTRICT TRANSFER FORM

This Form Must Be Renewed and Approved by the Superintendent Each Year

RETURN TO:
Big Walnut Local Schools Superintendent’s Office 110 Tippett Court Sunbury, OH 43074

DUE TO ENROLLMENT NUMBERS
		
YOUR CHILD WILL ATTEND
		
_________________________________ FOR THE 2023-2024 SCHOOL YEAR
		
Home Attendance Area _______________

1.	Student’s Name

2.	Parent/Legal Guardian’s Name

3.	Home Address

4.	Home Phone

5.	Home Attendance Area

6.	Request Transfer to

7.	Grade Level of Student for Upcoming Year?

Work Phone

□Big Walnut Elementary School □General Rosecrans Elementary School □Hylen Souders Elementary School □Prairie Run Elementary School

□Big Walnut Elementary School □General Rosecrans Elementary School □Hylen Souders Elementary School □Prairie Run Elementary School

8.	During the 2022/2023 school year, was your child attending his/her:
□Home Attendance School
□A Different School Through Intradistrict Transfer □Other
School Attended

9.	Has your child been suspended or expelled for ten (10) consecutive days or more at anytime during the current school year? □Yes
□No
10.	Does your child’s educational program include an Individualized Education Plan (IEP)? □Yes
□No

11.	An immediate family member (i.e. grandparent) provides my childcare.

Name______________________ Address____________________________ Phone____________

Attendance Area ___ Big Walnut Elementary ____ General Rosecrans Elementary ____Hylen Souders Elementary _____Prairie Run Elementary

12.	 On this back of this form please describe your extenuating circumstances that make it necessary to apply for an intradistrict transfer.

I understand I must provide transportation for my child(ren) as there are no plans in place at this time to provide transportation to the children on an intradistrict transfer plan.

Parent / Legal Guardian’s Signature

Date

OFFICE USE: Date Application Received ____________ Application Accepted ________     Denied________ ___________________________ Superintendent