AF 6212

Bluewater District School Board

351 1st Ave. N., Box 190, Chesley, Ontario N0G 1L0 (519) 363-2014 Fax (519) 370-2909 (Head Office)

APPLICATION FOR STUDENT TRANSFER BEYOND SCHOOL BOUNDARY

(Information collected on this form is confidential)
Application is to be taken or sent to the in boundary (normal) school by the parent or student.
Date of Application (yyyy-MMM-dd)
Student:
Telephone:
Surname	Given Name(s)
Address:
(Civic)	Number	Street
P.O. Box	Rural Route
Date of Birth:
City/Town/Village	Postal Code
yyyy - MMM - dd
BWDSB School This Student Would Normally Attend	Grade
BWDSB School This Student is Requesting to Attend	Grade
(in boundary)
(out of boundary)
Reason(s) for Request
Transportation is not required.	Transportation is required to and from address above
Transportation is required for special needs. Please complete TCF-A006
Transportation is required for childcare. Please complete TCF-A007
Transportation is required for joint custody. Please complete TCF-A008
Transportation Approved	Denied
Comment:
Conditions of Approval
1.	There is no additional expense to the board for staffing or facilities.
2.	Transportation is the responsibility of the parent/guardian. For extenuating circumstances application for transportation may be made above as appropriate. The student must meet the nearest bus and space must be available. Transportation may be withdrawn to provide space for in-boundary students. For more details see procedure TCP-A010 Out of Boundary Transportation.
3.	Program viability at the sending school.
4.	This approval is subject to annual review by the principal and it is understood that if conditions change the approval may be withdrawn.
To be Completed by Out of Boundary (Receiving) School Only
Date and Time Received:
Name of Parent(s) or Guardian(s) (Please Print)
Check One:
A.	Student has been accepted at:
Signature of Parent(s) or Guardian(s)
Name of School	Program/Grade
beginning
Month -- Year
Signature of In Boundary School Principal
B.	Student has not been accepted because:
cc:	Parent

In Boundary School

Transportation Consortium
Signature of Out of Boundary (Receiving) School Principal
Personal information on this form is collected under the authority of the Education Act, R.S.O. 1990, c.E.2, and will be used to determine the student’s eligibility to transfer to a school beyond school boundaries. Questions about this collection should be directed to the Principal of the school.
(Revised 2021.02.16) E-Template 2012.09.12	AP 6212-D, TCP-A010

BLC

2022-01-04

Holly Berner

Bluewater District School Boa