Prince George's Academy Homeschool Student Withdrawal Form

Student Withdrawal Form

2024-2025
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@scahomeschool.net if you have any questions or concerns.

Family Information
Guardian 1
Name*

First NameLast Name
Relation to student(s)*

FatherMotherGuardian
E-mail*
example@example.com
Guardian 2 (Optional)
Name

First NameLast Name
Relation to student(s)

FatherMotherGuardian
E-mail
example@example.com

Student Information
Child(ren)
(REQUIRED) Number of your children currently schooled at SHABACH! Christian 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)*

Family movingFinancial: tuition/cost too highDissatisfaction with academic programDissatisfaction with faculty or staff memberDissatisfaction with leadership/administrationDiscipline issuesClass size too smallClass size too largeChild's personal/emotional needs not metTransportation problemChild's friends/siblings at another schoolPoor communication with TutorsPoor communication with StaffProblem with school policiesLooking for different experience/atmosphere for childProblem with other studentOther
Other (Please specify)

Comments
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