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2013-2014 MAJORITY-TO-MINORITY TRANSFER WITHDRAWAL FORM

TO:

Deadline: August 2, 2013 Deadline to Return to Home Base School After First Semester: December 6, 2013

Mr. Lionel Jackson, Assistant Superintendent Chief Desegregation Implementation Officer

FROM: ________________________________________________________________________________________________ Parent/Legal Guardian ADDRESS: ___________________________________________________________________________________________ CITY: _______________________________________ STATE: ____________________ ZIP CODE: _____________

Dear Mr. Jackson, I, ____________________________________, have decided to withdraw my Majority-to-Minority application for my child/children listed below to attend __________________________________ for the 2013 – 2014 school year.

(Minority School)

1. ________________________________________________ 2. ________________________________________________ 3. ________________________________________________ I would like to have my child to attend his/her assigned attendance zone school listed below. __________________________________________________________________ Attendance Zone School Sincerely, __________________________________________ Signature of Parent/Legal Guardian

__________________________ Date (For Desegregation Use Only)

[ [

] Approved ] Denied

_______________________________________________ Chief Desegregation Implementation Officer Cc: File Principal Transportation Director

_____________________ Date


2013 2014 majority to minority withdrawal form