INSTRUCTIONS:
This form must be typed. This form will be submitted for each student requiring
eligibility certification for
FORM B GEORGIA HIGH SCHOOL ASSOCIATION
TRANSFER P.O. Box 271
STUDENT Thomaston, GA 30286-0004
(2002-2003) 706-647-7473 FAX: 706-647-2638
Certificate of Eligibility - TRANSFER STUDENT |
SCHOOL CITY ____________
ACTIVITY SCHOOL YEAR REGION AND CLASSIFICATION_____ ___
INSTRUCTIONS:
This form must be typed. This form will be submitted for each student requiring
eligibility certification for
interscholastic competition who has transferred to your school from a NON-FEEDER school in the past twelve (12) calendar months.
REGULAR SCHEDULE
BLOCK SCHEDULE (see By-Law # 1.53) |
DATE OF BIRTH |
DATE STUDENT ENTERED NINTH GRADE (courses taken prior to 9th grade entrance can not be used for eligibility purposes) |
GRADE (This School Year) |
TOTAL COURSES PASSED Previous Quarter or Semester |
TOTAL UNITS ACCUMULATED |
(This Column for GHSA use only) ELIGIBILITY STATUS |
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NAME List Alphabetically – By Grades
LAST FIRST MIDDLE
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Mo. |
Day |
Year |
Mo. |
Day |
Year |
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Beginning & Ending Dates Attended Beginning with 9th
grade Grade Name of
School Address (City, State) |
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Present Home Address _________________________________________ ____________________________________________ (City, State) Lives With ___________________________________________________ ____________________________________________ (Names) (Relationship) Pupil lived with while attending previous school_________________________________________ ____________________________________________ (Names) (Relationship) Previous home address ___________________________________________ ____________________________________________ (Street) (City, State)
Date student enrolled at your school __________________________________________________________________________________ (Month, Day, Year)
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Did the parent(s) have a bonafide change of address from previous school area to your service area? ________________________________
Is custodial parent a certified teacher or administrator at the receiving school? __________________________________________________
Has this student been suspended or expelled (or facing suspension or expulsion) from the previous school?___________________________
If this is a foreign exchange student, please list name of exchange program. _____________________________________________________
Note: If this transfer is due to a divorce or change of custody from one natural parent to another natural parent, attach a copy of the court awarded custody order from a court of proper jurisdiction.
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SIGNED ___________________________________________________ _____________________________________________
(Superintendent or Principal or Assistant Principal-No Stamps) (Report Preparer)
DATE ____________________________________________________