540B
June 29, 2010
Page 1 of 1
Discretionary Student Transfer
Discretionary Student Transfer Information
TO BE COMPLETED BY SENDING SCHOOL ADMINISTRATOR
Student Number:
#
Last Name of Student:
First Name of Student:
Insert last name of student and TAB to the next prompt
Apt./Unit:
City:
Home:
Father’s Name:
Home:
Name of Sending Principal/Vice-Principal:
SE
SW
Month
#
F
dd
Postal Code:
Bus:
Name of Receiving School:
yy
Telephone Number:
___________________________________________________
(Signature of Principal/Vice-Principal)
Is the student identified as exceptional?
Yes
No
Is the student receiving Special Education support?
Yes
No
Is the student English Second Language/Dialect?
Yes
No
Documents to be Attached:
Trillium Index Card
Credit Counselling Summary
History of Suspension
IEP
IPRC Decision Sheet
A. ACADEMIC NEEDS
B.
Presently Receiving
Requiring
Presently Receiving
Requiring
Academic Courses
Applied Courses
Technical Courses
Essential Courses
Learning Strategies
Semestered Program
Non-Semestered-Program
SUPPORT SERVICES
Special Education
Social Worker
Tutoring Program
Guidance Counselling
Attendance Counselling
Other (outside services)
C. Administrator’s Comments: (Why are you recommending the transfer or other pertinent information?)
Victim
Compassionate
Other
Note: Student Athletes must complete the TDSB Athletic Transfer Eligibility Form and meet the TDSB requirements in order to participate.
Copies to:
Ontario Student Record
Special Education Consultant
G02(D:\533577538.doc)sec.1530
Sending Principal
Safe and Caring Schools Administrator
#
Month
Bus:
Date: (dd, Month, yy)
dd
#
Province:
Mother’s Name:
NW
#
#
DOB: (dd, Month, yy)
M
Telephone Number(s):
Education Office:
#
Gender:
Parent / Guardian Name(s):
NE
#
Insert first name of student
Address:
Name of Sending School:
#
Superintendent of Schools
yy