LCCA Student Withdrawal Form

LCCA Student Withdrawal Form
Student's Full Name*
Current Grade Level*
Parent/Guardian Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please select the reason for student's withdrawal.*

RelocationTransfer to another schoolEducational ReasonsFinancial ReasonsHealth ReasonsOther
Please Specify*
Effective Withdrawal Date *

MonthDayYear
Date
Last Date of Attendance at LCCA*

MonthDayYear
Date
Feedback (Optional):We value your feedback and would appreciate any comments or suggestions you may have about your experience at LCCA. Your insights can help us continually improve our programs and services.
Please return all school property, including but not limited to textbooks, library books, and any other items issued by LCCA, on or before the last day of attendance.
I acknowledge that I have completed this withdrawal form and understand that my child's enrollment at Little Cypress Christian Academy will officially end as of the effective withdrawal date. I confirm that all school property will be returned by the specified date.*

Yes
I acknowledge Little Cypress Christian Academy's 30 day notice of withdrawal policy. Parents/Guardians wishing to withdraw their child(ren) from LCCA should give a 30 day notice. The withdrawal process is complete and student records will be released when all financial obligations have been met.*

Yes
Signature

Clear
Should be Empty:

Please return all school property, including but not limited to textbooks, library books, and any other items issued by LCCA, on or before the last day of attendance.