SUGAR CREEK CHARTER SCHOOL
STUDENT WITHDRAWAL FORM
Student Name
Date of Birth
Address
Apt Unit
City
State
Zip Code
Home Phone Number
Cell Phone Number
Parent/Guardian Name
Grade Level
Reasons for leaving Please provide detailed explanation
Receiving school information: (For the transfer of student records)
Phone #
City
State
Zip Code
Type of school
Public
Charter
Home
Private
Technical
Type option 6
Effective Date of Withdrawal
-
Month
-
Day
Year
Date
Parent/Guardian Signature
Date
/
Month
/
Day
Year
Date
Upload Government Issued of ID of Parent/Guardian
*
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