School Withdrawal Form

School Withdrawal Form

Please fill out this form to officially withdraw your child from your current school.
Today's Date*

MonthDayYear
Date
Parent/Guardian's Full Name*

First NameLast Name
Parent/Guardian's Email
example@example.com
Parent/Guardian's Phone Number
Please enter a valid phone number.
Student(s) to Withdraw (list all students: first & last name)*
Residence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date*

MonthDayYear
Date
Current School (Withdrawing From)*
Current (Withdrawing From) School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New School Name*
New School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Withdrawal Statement

This is to notify you that I will be withdrawing the above-listed children to enroll them in a new public/private/charter school pursuant to § 48222 of the California Education Code. You will be receiving a letter from the new school requesting records for the above-listed students. If you have any questions, please feel free to submit them in writing.
Parent/Guardian Signature*

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