GMCS Student Withdrawal Form
This form must be submitted at least 30 days prior to the student's last day of school.
Student Name
First Name
Last Name
Student Date of Birth
Please enter date of birth.
Parent Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Grade
Please Select
K4
K5
1
2
3
4
5
6
7
8
9
10
11
12
What is the reason for your withdrawal?
Have you already talked to the Administrator?
Yes
No
The last day of school will be:
Please enter the student's last day of school.
Are you planning to return to the school in the future?
Yes
No
Reminders
All current tuition payments and after school care payments must be paid in full prior to withdrawal.
There will be no refund on the tuition or any other fees for the month during which withdrawal notice is given. Parents/guardians will be financially responsible for the tuition and fees based on this policy, without regard to the reason why you are withdrawing. No exceptions.
All Chromebooks and school-issued calculators must be returned to the office.
All library books must be returned to the library.
No school records will be released until the withdrawal process has been completed and the financial account is fulfilled.
If a Junior or Senior is taking concurrent college classes from UAHT and withdraws from GMCS, they are still responsible for their college classes as well as any funds owed to UAHT.
Students who are dismissed for failure to comply with school policies may not be given notice; however, the remainder of the above statements are in effect.
Signature
Date Signed
-
Month
-
Day
Year
Date
For Office Use Only
Withdrawn By
Withdrawal Date
-
Month
-
Day
Year
Date
Print
Submit
Should be Empty: