Prince George's Academy Homeschool Student Withdrawal Form

Student Withdrawal Form

2025-2026
INSTRUCTIONS: Please read and complete each section. All students who are withdrawing from the program should be included on this form (name, grade, group, current school year, & effective date of withdrawal). A copy of the completed form will be sent to the Homeschool Administrative Office and a copy will also be sent to the parent/guardian email addresses provided in the fields below. Please email us at info@pgcahomeschool.org if you have any questions or concerns.
- Guardian 1
- Name
  
  First NameLast Name
- Relation to student(s)
- E-mail
  example@example.com
- Guardian 2 (Optional)
- Name
  
  First NameLast Name
- Relation to student(s)
- E-mail
  example@example.com
- Child(ren)
- (REQUIRED) Number of your children currently schooled at Prince George's Academy Homeschool
- Child 1
- Student's Name
  
  First NameLast Name
- Current Grade:
- Current Group:
- Current School Year
- Effective withdrawal date
  
  MonthDayYear
- Child 2
- Student's Name
  
  First NameLast Name
- Current Grade:
- Current Group:
- Current School Year
- Effective withdrawal date
  
  MonthDayYear
- Child 3
- Student's Name
  
  First NameLast Name
- Current Grade:
- Current Group:
- Current School Year
- Effective withdrawal date
  
  MonthDayYear
- Child 4
- Student's Name
  
  First NameLast Name
- Current Grade:
- Current Group:
- Current School Year
- Effective withdrawal date
  
  MonthDayYear
- Child 5
- Student's Name
  
  First NameLast Name
- Current Grade:
- Current Group:
- Current School Year
- Effective withdrawal date
  
  MonthDayYear
- Child 6
- Student's Name
  
  First NameLast Name
- Current Grade:
- Current Group:
- Current School Year
- Effective withdrawal date
  
  MonthDayYear
- What is the reason for which your family is leaving the school? (please select all that apply)
  
  Other
- Other (Please specify)
- Your comments are important to us:
- Thank you for providing this information to us. We wish you and your family all the best at your new school.
- Should be Empty:

Student Withdrawal Form

Guardian 1

Guardian 2 (Optional)

Child(ren)

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6