Change of Student Info Form

Change of Student Info

Person Completing this Form:

Type of Change:

Information Change

Student Name:

Student ID Number:

Grade:

Parent Name:

New Address (If Applicable):

Telephone

Home:

Cell:

Work:

Email:

Address Change Applies to:

If entire family is affected, list siblings:

Program Change/Withdrawal

Last Day of Attendance:

Previous Program:

New Program:

New Program Start Date:

Grade Change

From:

To:

Homeroom Change

From:

To:

Special Education:

Placement Outside of District:

Career-Tech Program:

Drop-Out

If Student is a Drop-Out, what are the student's plans?

  1.  Work
  2.  G.E.D
  3.  Military
  4.  Unknown

Transfer to a new School:

New School Name:

New School Address:

Student Schedule:



Security Measure