Request for a Change of TOSS Placement -- Fall 2009

NOTE: No change in placement is guaranteed. Change in school placement may (or may not) result in a change in section for TOSS classes.

Things to consider:

*No change in placement is guaranteed.

*Requests are considered on an individual basis.

*In general we cannot make changes based on distance from KSU alone.

*Changes in section are not guaranteed with change in school. (The number in any one section is set and unless space opens up, there are no seats available.)

*Changes in PE section will not affect your school or TOSS sections.

Please fill in all of the information below:

* Required

Last Name *

First Name *

KSU Number *

Cell Number * (If you don't have a cell number, please enter n/a.)

Home Number * (If you don't have a home phone, please enter n/a.)

KSU E-mail Address *

Current TOSS School Placement *

Current TOSS Section Placement *

Current HPS 3670 Placement *

Four Alternative Schools

Below, please list 4 schools that would meet your needs. (If the schools you request are on our current list, they probably will not have available openings.) DO NOT CALL A SCHOOL AND TRY TO ARRANGE AN ALTERNATE PLACEMENT. ATTEMPTS TO DO SO WILL RESULT IN DENIAL OF PLACEMENT REQUEST.

School 1: * (If the schools you request are on our current list, they probably will not have available openings.) DO NOT CALL A SCHOOL AND TRY TO ARRANGE AN ALTERNATE PLACEMENT. ATTEMPTS TO DO SO WILL RESULT IN DENIAL OF PLACEMENT REQUEST.

School 2: * (If the schools you request are on our current list, they probably will not have available openings.) DO NOT CALL A SCHOOL AND TRY TO ARRANGE AN ALTERNATE PLACEMENT. ATTEMPTS TO DO SO WILL RESULT IN DENIAL OF PLACEMENT REQUEST.

School 3: * (If the schools you request are on our current list, they probably will not have available openings.) DO NOT CALL A SCHOOL AND TRY TO ARRANGE AN ALTERNATE PLACEMENT. ATTEMPTS TO DO SO WILL RESULT IN DENIAL OF PLACEMENT REQUEST.

School 4: * (If the schools you request are on our current list, they probably will not have available openings.) DO NOT CALL A SCHOOL AND TRY TO ARRANGE AN ALTERNATE PLACEMENT. ATTEMPTS TO DO SO WILL RESULT IN DENIAL OF PLACEMENT REQUEST.

Reason for your request: * Please be specific in your explanation.

Please Remember:

*No change in placement is guaranteed. *Requests are considered on an individual basis. *In general we cannot make changes based on distance from KSU alone. *Changes in section are not guaranteed with change in school. (The number in any one section is set and unless space opens up, there are no seats available.) *Changes in PE section will not affect your school or TOSS sections.