SJCA Withdrawal Form

SJCA Withdrawal Form
Student Name

First NameLast Name
School
Grade
Anticipated Last Date of Attendance

MonthDayYear
Are you a WPCP (Wisconsin Parental Choice Program) Recipient? *
Are you a SNSP (Special Needs Scholarship Program) Recipient? *
Would you be willing to complete an exit survey to better help us serve future and current students?*

YesNo
Comments:

I, the parent of student name* . hereby acknowledge that my student will no longer be enrolled at St. Joseph Catholic Academy.
Signature*

I, the parent of student name* . hereby acknowledge that my student will no longer be enrolled at St. Joseph Catholic Academy and therefore will forfeit the seat with the Wisconsin Parental Choice Program.
Parent/Guardian Name*

First NameLast Name
Signature*

I, the parent of student name* . hereby acknowledge that my student will no longer be enrolled at St. Joseph Catholic Academy and therefore will forfeit the seat with the Special Needs Scholarship Program.
Parent/Guardian Name*

First NameLast Name
Signature
Should be Empty: