Choice Program Palm Beach Form – Fill Out and Use This PDF

THE SCHOOL DISTRICT OF PALM BEACH COUNTY

DEPARTMENT OF CHOICE AND CAREER OPTIONS

IMPORTANT STUDENT REASSIGNMENT INFORMATION

Instructions on submitting a reassignment request are listed below. Please note that submitting an application does not guarantee approval into requested school. Submission of your request must be reviewed in accordance with school board policy 5.015, which can be viewed at www.palmbeachschools.org/policies/ (Chapter 5). The application must be complete and all required documentation must be attached or application will not be processed.

You must meet the following requirements to request student reassignment:

1.Parent/Legal Guardian must be permanent residents of Palm Beach County and/or have been issued a Palm Beach County student ID number. Incoming Kindergartners without a student ID number must first register at their zoned school to obtain a student ID number.

2.The requested school must be available pursuant to School Board Policy 5.015. To see the entire Policy go to http://www.palmbeachschools.org/choiceprograms/ReassignmentInfo.asp, (Chapter 5).

3.Palm Beach County school district employees who reside out of county must obtain a release from their home county prior to submitting a request for reassignment into Palm Beach County.

Important information about student reassignment:

•Due to the reasons set forth in Policy 5.015, paragraph twelve, a student may be returned to his/her assigned attendance area school if:

1.the student becomes a discipline and/or attendance problem.*

2.the student's parent or guardian is unable or unwilling to work with the policies and procedures of the reassigned school.*

3.the reasons for reassignment are no longer valid, or the reasons for registration or reassignment were fraudulent.*

4.the student withdraws from the reassigned school.*

5.the school's utilization has increased to 100% of the capacity.*

*Parents may be informed that they are no longer able to remain at the reassigned school at any time prior to the beginning of the new school year and/or during the school year pursuant to policy 5.015

Submit this completed and signed form to the Department of Choice and Career Options, 3308 Forest Hill Boulevard, C-124, West Palm Beach, FL 33406-5869 or fax to 561-434-8843.

Read the preceding page, "Important Student Reassignment Information" carefully before completing this application. Submit this completed and signed form to the Department of Choice and Career Options, 3308 Forest Hill Boulevard, C-124, West Palm Beach, FL 33406-5869 or fax to (561) 434-8843.

*A copy of the student's Individual Education Plan (IEP), ELL or 504 Plan MUST be attached to this application.

Student is requesting to be reassigned to (name of school)

What is the school attendance area in which the student now lives?

What is the reason the student is requesting reassignment (choose all that apply) per School Board Policy 5.015?

A letter with specific reason(s) why reassignment is being requested

to the school listed above MUST be attached to each request or it may not be processed)

I understand and agree to all of the following:

1.I understand that Reassignment Requests are accepted April 1 through June 1 only for the upcoming first semester and October 1 through 31 only for second semester, with limited exceptions.

2.I realize certain schools are not available pursuant to the rules in School Board Policy 5.015, such as schools with enrollment above capacity and schools in the first year of operation. A list of schools that are open to reassignment is available at the Department of Choice and Career Options Office or on the web at www.palmbeachschools.org/ choiceprograms. A current list is posted each semester and is subject to change at any time due to capacity and/or school district/department decisions.

3.The results of the request will be e-mailed or mailed to the above address. Telephone requests for results cannot be honored due to privacy issues.

4.My signature below verifies that I declare, under perjury, pursuant to Florida Statute, Section 92.525, that I have read this application and the information stated in this application is true and correct. I understand that I have the opportunity to ask questions and receive information regarding the reassignment policy. I also agree to the provisions in this form, and the important information, including the reasons under Policy 5.015(12) that a student may be required to return to his/her assigned attendance area school.