Student Withdrawal Request Form
DIVINE ACADEMY SCHOOL OF THE ARTS
Date of Withdrawal Request Made
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Student's Name
*
First Name
Middle Name
Last Name
Suffix
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
School Year
*
Please Select
SY 2020-2021
Grade Level
*
Please Select
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
New School of Attendance
Please Select
Charter School
Private School
Public School
Homeschool
Please indicate the name of the school district and/or other, the address, phone number, and/or email address where you need the school to send official documents to.
*
Terms and Agreements
All outstanding obligations to the school must be paid in order for the school to release official certified copies of the student's transcript.
The student's cumulative folder will be given to the parent/guardian after the school uploads the electronic copy of selected documents from the folder and into the student's electronic portfolio.
PARENT/LEGAL GUARDIAN AGREEMENT
*
By checking this box, as the parent/guardian of the student above, I verify that the information is accurate, and I agree to the terms of the transfer request.
Parent/Guardian's Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Relationship to Student
*
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Signature
*
Submit
Submit
Should be Empty: