Cobb County School District s3

Form JBCD-4

REQUEST TO CONTINUE ENROLLMENT (Cobb County School District Residents Only)

School: School Year: Should the parent/guardian of a student enrolled in the District move from one attendance zone to another within the District, the parent/guardian may apply for their student to remain enrolled in his/her current school. Pursuant to Administrative Rule JBCD-R (Transfers) the following student has applied to remain enrolled in his/her current school. For students approved to remain enrolled the following provisions apply:  The parent/guardian must promptly report to the principal or designee any change in circumstances by which the student is no longer a resident of the District;  Transportation for students approved to continue enrollment must be provided by the parent/guardian;  Acceptable attendance, behavior and grades are required in order for the student to be approved and remain on transfer;  The parent/guardian is expected to maintain a cordial and cooperative working relationship with school personnel;  Failure to comply with any provisions of this paragraph shall authorize the principal to immediately withdraw such student; and  If the student transfers at the high school level, he/she must meet Georgia High School Association requirements to participate in competitive interscholastic activities.

This application must be fully completed. PLEASE PRINT OR TYPE One form per student

Student Name: Student ID #: (can be found on report card & progress reports) Date of Birth: Grade: Age: Gender:

Parent/Guardian Name:

Old Cobb County Address:

Apartment Complex Name: Apartment Number:

City: Zip:

New Cobb County Address:

Apartment Complex Name: Apartment Number:

City: Zip: E-mail:

Phone: Home: Cell:

Date of Move: [documentation required (e.g. proof of residency)]

Parent/Guardian Signature: Date:

PLEASE DO NOT WRITE BELOW THIS LINE SCHOOL USE ONLY ************************************************************************************************************ Approved This transfer is approved for the current school year only and may not be renewed

7/1/16: Student Support *JBCD-4* Page 1 of 2 Denied Principal Signature: Date:

Original: To be filed in student record Copy: To be sent to Student Support

7/1/16: Student Support *JBCD-4* Page 2 of 2