ALLEN BILL TRANSFER

Allen Bill

A parent or guardian who is physically employed within the Pomona USD school boundaries for a minimum of 10 hours per week can enroll their student through the Allen Bill enrollment option. Parents or guardians can enroll their student(s) directly to Pomona Unified School District by completing an online Allen Bill Application and providing verification of employment within our district boundaries (i.e. pay stub, verification of employment on business letterhead).

Please complete the form below. Required fields marked with an asterisk *

Student Information

Last Name:*

Answer Required

First Name*

Answer Required

Date Of Birth*

Answer Required

Grade*

Answer Required

Street Address:*

Answer Required

City:*

Answer Required

Zip/Postal:*

Answer Required

Home Phone:*

Number Required

Alternate Phone:

Number Required

School Last Attended:*

Answer Required

District Last Attended:*

Answer Required

District of Residence:*

Answer Required

Currently Enrolled In A Special Program:

Answer Required

Adaptive Physical Education (APE)

Resource Specialist Program (RSP)

Special Day Class (SDC)

Specialized Physical Health Care

Gifted and Talented Education (GATE)

Limited English Proficiency (LEP)

Speech/Language Program

Free/Reduced Lunch Program

PUSD WILL NOT BE RESPONSIBLE FOR ANY ADDITIONAL EXPENSES FOR OUT OF DISTRICT STUDENTS.

Per California Education Code 48204(b)(3) Pomona Unified School District under this subdivision may prohibit the transfer of the pupil if the district determines that the additional cost of educating the pupil would exceed the amount of additional state aid received as a result of the transfer.

NOTE: Reapplication and/or re-verification may be required. Transportation is the parent's responsibility. This transfer may be denied and/or revoked if false information is submitted, if the student demonstrates poor attendance, unacceptable behavior or if there is not sufficient space available to accommodate the student's enrollment.

Name of Parent/Guardian:*

Answer Required

Is the student under an expulsion order?:*

Answer Required

Yes

Upload verification of employment within our district boundaries (i.e. pay stub, verification of employment on business letterhead). *

Answer Required

Choose a file or drag it here.

If the student applying has a sibling attending the requested school(s), please provide the name of the sibling

Sibling Last Name:

Answer Required

Sibling First Name:

Answer Required

Please fix the highlighted areas below before submitting.

ALLEN BILL TRANSFER