GCSEC Student Drop Form

Student Name*
Serving School*
Resident District*
Program/Service Dismissed from*
Teacher/Therapist Name*
Reason for Exit:*
Example: Moved, Not Eligible, Not Eligible, Other (please explain)
Exit Date*

MonthDayYear
(last day attended or serviced)
Notes
This should be completed for each student that drops or is dismissed from your program/class to ensure accurate state reporting. If you have questions please let Phoebe know. Thanks!
Should be Empty: