Student Verification Form

Date of Transfer:

Name of District: Scotch Plains-Fanwood

CDS Code: 060

Student Name:

Grade:

Name of School: Malcolm E. Nettingham Middle School

Date of Birth:

Name of Parent/Guardian:

Contact Phone Number:

Student’s Current Address: 

Student’s New Address:

S

                            School Address:___________________________________________________________________________________________

                         ________________________________________________________________________  Phone:______________________________

Signature:

Print:

       (T3) Transfer to a nonpublic school within the state. Documentation is a written request for student records from the nonpublic or a written acknowledgement of receipt of the records by the non public school.  Date records are sent:

     (T4) Transfer to any public school outside the district but within the state. Documentation is notation of the successful release of the SID to the receiving district. Date:                      

     (T6) Incarceration in a state or county entity with and educational program that leads to a regular high school diploma. Documentation is an official request for student records and notation of successful release of the SID to the institution, where applicable. Date:                   

    (T7) Transfer to a state or county institution for the treatment of a physical, mental, or emotional disability. Documentation is an official request for student records and notation of successful release of the SID to the institution, where applicable. Date:                             

 ____(T8) Transfer out of the state or country. Documentation of transfer to a school in another state requires a written response from an official in the receiving school or program acknowledging the student’s enrollment. Date:                

documentation of transfers out of the country is verified by the parent/guardian’s signature above.

     (T9) Home-schooled

     (TC) Transfer to a charter school. Documentation is notation of the successful release of the SID to the receiving charter school. Date:                  

      (TD) Transfer to a choice school. Documentation is notation of the successful release of the SID to the receiving choice district. Date:                 

      (T9) Deceased- The signature of the parent/guardian attesting that the student is deceased. Signature: