Secondary In-District Transfer Application 2023-2024

PLEASE NOTE: In-district transfer is a privilege and may be rescinded based on student behavior, attendance or lack of academic performance.

ALREADY TRANSFERED WITHIN THE DISTRICT? Students previously approved for secondary in-district transfer do not need to reapply unless they are currently on an conditional status.
Parent/Guardian First Name*
Parent /Guardian Last Name*
Parent/Guardian Phone
Parent/Guardian Email
Student First Name*
Student Last Name*
Student Date of Birth*
Month
Day
Year
Student Grade Level for the 2023-2024 School Year*
Current Home Address*
Street Address Apartment/Lot Number City State ZIP Code
Have you moved since last year?*
- Yes
- No
Previous Home Address
Street Address Apartment/Lot Number City State ZIP Code
Does the student receive special education services?*
- Yes, the student has an IEP (Individualized Education Program)
- No
Is the student currently enrolled in the Dubuque Community School District?*
- Yes
- No

School the student is currently attending:*
School requesting to attend:*
Reason for requesting in-district transfer.*
CHECK ALL THAT APPLY. Depending on the reason you select, additional details or documentation may be required. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.
- Medical Reasons (must provide physician's statement specific to the requested building)
- Legal Reasons (must provide police or court order)
- Continued attendance at requested school following move OUT of school boundary (must provide move date)
- Imminent and documented move INTO the requested school boundary (must provide purchase/rental agreement)
- Sibling(s) from same home address attend(s) requested school during the 2023-2024 school year (must provide names and grade levels)
- Parent/guardian assigned full-time to the requested school during the 2023-2024 school year (must provide name and position)
- Extenuating circumstances as defined by Policy #1001 Anti-Harassment/Bullying and/or Policy #1005 Anti-Discrimination (must attach copy of Harassment/Bullying/Discrimination Form(s) previously filed at current school).
- Extenuating circumstances which would create a hardship significantly affecting the learning progress of the student for whom open enrollment is requested (must provide explanation)

Sibling name(s) and grade level(s) for the 2023-2024 school year:*
Parent/guardian name assigned to requested school and position:*
Upload physician's statement
Max. file size: 80 MB.
NOTE: Documentation not uploaded must be provided in hard copy to the Dubuque Community School District Superintendent's Office in order for this application to be considered.
Upload police or court order
Max. file size: 80 MB.
NOTE: Documentation not uploaded must be provided in hard copy to the Dubuque Community School District Superintendent's Office in order for this application to be considered.
Date student moved out of boundary:*
Month
Day
Year
Upload purchase/rental agreement
Max. file size: 80 MB.
NOTE: Documentation not uploaded must be provided in hard copy to the Dubuque Community School District Superintendent's Office in order for this application to be considered.
Upload Harassment/Bullying/Discrimination form(s) previously filed at the student's current school
Max. file size: 80 MB.
NOTE: Documentation not uploaded must be provided in hard copy to the Dubuque Community School District Superintendent's Office in order for this application to be considered.
Please describe extenuating circumstances below.*
Additional comments regarding your application.
Acknowledgement*
By clicking below, I agree that I am the legal parent/guardian of the student for which in-district transfer is being requested.

I HAVE READ AND UNDERSTAND POLICY #6218 IN-DISTRICT TRANSFER and understand that this policy governs the in-district transfer process.

I also agree that my application will not be considered if I have not submitted the required additional documentation. Documentation not uploaded on this form must be submitted in hard copy to:

Superintendent's Office
Dubuque Community School District
2300 Chaney Road
Dubuque, Iowa 52001
- I agree

Secondary In-District Transfer Application 2023-2024

Secondary In-District Transfer Form - 2023-2024