First Name:
Last Name:
Alaska Student ID:
School Losing Student:
Choose One
Brevig Mission
Diomede
Elim
Gambell
Golovin
Koyuk
Savoonga
Shaktoolik
Shishmaref
St. Michael
Stebbins
Teller
Unalakleet
Wales
White Mountain
Transfer to another BSSD school?:
Choose One
No - Out of District
Brevig Mission
Diomede
Elim
Gambell
Golovin
Koyuk
Savoonga
Shaktoolik
Shishmaref
St. Michael
Stebbins
Teller
Unalakleet
Wales
White Mountain
Transfer to another Alaskan district?:
Choose One
No - See above
No - Out of State
Alaska Gateway
Aleutian Region
Aleutians East Borough
Alyeska Central Correspondence
Anchorage
Annette Island
Bristol Bay Borough
Chatham
Chugach
Copper River
Cordova
Craig
Delta/Greely
Denali Borough
Dillingham
Fairbanks
Galena
Haines
Hydaburg
Iditarod Area
Juneau
Kake
Kashunamiut
Kenai Peninsula
Ketchikan Gateway
Klawock
Kodiak Island Borough
Kuspuk
Lower Kuskokwim
Lower Yukon
Mat-Su Borough
Mt.Edgecumbe
Nenana
Nome
North Slope Borough
Northwest Arctic Borough
Pelican
Petersburg
Pribilof Islands
Saint Mary's
Sitka Borough
Skagway
Southeast Island
Southwest Region
Tanana
Lake & Peninsula
Unalaska
Valdez
Wrangell
Yakutat
Yukon Flats
Yukon Koyukuk
Yupiit
Other - Distance Learning
Other - Juvenile Corrections
Other - Residential Treatment
Reason for Exit:
Choose One
(1) - Transfer to a public school in BSSD
(2) - Transfer to a public school in a different district in Alaska
(3) - Transfer to a public school in a different state or country
(5) -Transfer to a private school
(6) - Transfer to an institution (with an educational program)
(7) - Graduated with regular diploma
(8) - Graduated with regular diploma under a waiver
(9) - COA (certificate of attendance or achivement)
(10) - Death
(11) - Maximum age and did not receive a diploma or COA
(12) - Dropped Out
(13) - Finished year as 12th grader & expected to return
(14) - Finished year as PK-11th grader & returning
Drop Reason:
Choose One
Not a Drop - See Exit Info Above
10+ Days Unexcused Absence
Truancy
Kindergartner -stopped coming
Transfer to Home Schooling
Left for unknown reasons
Employment
Family problems
Pregnancy
Alcohol/drug dependency
Illness
Expulsion due to behavior
Pursuing GED
Entering military
Testing Level:
Choose One
PK - 3 year-old
PK - 4 year-old
K
1
2
3
4
5
6
7
8
9
10
11
12
12+
Graduate
Last Date of Attendance:
Date of Birth (MM/DD/YYYY):
Gender:
Choose One
Male
Female
Is this a Special Education student?:
Choose One
No
Yes
Not sure
If YES, have Special Ed records (including discipline files) been sent to the new school?::
Choose One
Yes
No
Records Request Not Received
Not Sure
Person Requesting Transfer:
Choose One
School Secretary
Counselor
Principal
Your Email Address:
Comments: