Form JBCD-5
Empowering Dreams for the Future
SENIOR ATTENDANCE PERMIT
School:
Semester:
Pursuant to Administrative Rule JBCD-R (Transfers) the following Cobb County School District SENIOR has
applied to remain as a student here for this school year. Documentation is attached verifying that the move out
of the District/zone occurred after completion of the junior year. Acceptable student attendance, behavior, and
grades as well as a cordial and cooperative working relationship between the parent/guardian and school
personnel are required in order for this to be approved and in order to remain valid. Bus transportation is not
provided.
This application must be fully completed.
PLEASE PRINT OR TYPE
Student Name:
Parent/Guardian Name:
Previous Address:
Apartment Complex Name:
City:
Apartment Number:
Zip:
New Address:
Apartment Complex Name:
City:
Apartment Number:
Zip:
Phone: Home:
Date of Move:
E-mail:
Cell:
(documentation required)
Parent/Guardian Signature:
Date:
PLEASE DO NOT WRITE BELOW THIS LINE
SCHOOL USE ONLY
******************************************************************************************
Approved
Denied
Principal Signature:
Date:
Original: To be filed in student record
10/08/14: Student Support
Copy: To be sent to Student Reporting
*JBCD-5*
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