Student Exit Form

Student Exit Form
Student Details
Full name*

First NameLast Name
Year level*

Parent Details
Full name*

First NameLast Name
Relationship to student*
For students whose enrolment contract lists two parents or guardians, the school requires the names and signatures of both individuals on the exit form.
Would you like to add another Parent/Guardian to the exit form?*

YesNo
Full name*

First NameLast Name
Relationship to student*

Last day of attendance*

DayMonthYear
Date
Exit meeting with the School Principal*

I/We would like a meeting with the Principal regarding this exitI/We do not require a meeting with the Principal regarding this exit

Reason for leaving*

Family RelocationChange of SchoolFinancial ReasonsFurther EducationSchool Issues (e.g. peer issues, subject selection)Other
Please provide details about further education, e.g. TAFE, apprenticeship, traineeship.*
Please provide details about school issues, e.g. teacher concerns, peer issues, subject selection.*
Please provide further details about the reason for leaving.*

Are you transferring interstate or to another NSW school?*

Transferring interstateTransferring to a NSW schoolNeither (e.g. TAFE, apprenticeship)
Please provide details of the new school, if applicable
Please declare below if you do or do not give permission for information about your child to be transferred from St Columba Anglican School to their new school (details as noted above).
Authority to release student data*

I/We give permissionI/We do not give permission
Declarations
1. The Principal (or delegate) of my child’s new school may request and/or receive information from St Columba Anglican School verbally and/or in writing.
2. It may include all details contained in the Interstate Student Data Transfer Note.
3. My child’s new school may require additional information. This information will only relate to information on the flagged field on the Interstate Student Data Transfer Note.
4. The Principal (or delegate) of my child’s new school may contact the Principal (or delegate) from St Columba Anglican School both verbally and/or in writing.
5. I can request to see the information that is received from St Columba Anglican School.
6. I understand that my child’s new school will take all reasonable steps to protect the personal information about me/my child from misuse and loss and from unauthorised access, modification or disclosure.
Please refer to the website https://www.education.gov.au/transferring-student-data-interstate for information regarding the Interstate Student Data Transfer Note.
Signature of Parent/Guardian 1*

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By signing here, you expressly consent to receiving these terms and conditions electronically and acknowledge that all other notices or documents required to be given in respect to the terms and conditions may be sent to you by electronic communication. You acknowledge and agree that any agreement formed upon the signing of these terms and conditions has originated from, and is deemed to have been formed in the location of, St Columba Anglican School.
Signature of Parent/Guardian 2*

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By signing here, you expressly consent to receiving these terms and conditions electronically and acknowledge that all other notices or documents required to be given in respect to the terms and conditions may be sent to you by electronic communication. You acknowledge and agree that any agreement formed upon the signing of these terms and conditions has originated from, and is deemed to have been formed in the location of, St Columba Anglican School.

Account Finalisation
Forwarding address (if relocating)

Street Address

Street Address Line 2

CityState / Territory

Post Code
Current email
example@example.com
Account Details

Upon account finalisation, I request that any refunds applicable be refunded as follows:
Parent/Guardian 1

First NameLast Name
Account name
BSB
Account number
Please provide details separately if the School account has been held in joint names and requires the balance to be distributed equally.
Parent/Guardian 2

First NameLast Name
Account name
BSB
Account number
Direct Debit arrangements (where applicable) will cease following final settlement of your School account, otherwise you will be contacted by the Accounts Department to discuss.
Signature of Parent/Guardian 1*

Powered by Jotform SignClear
By signing here, you expressly consent to receiving these terms and conditions electronically and acknowledge that all other notices or documents required to be given in respect to the terms and conditions may be sent to you by electronic communication. You acknowledge and agree that any agreement formed upon the signing of these terms and conditions has originated from, and is deemed to have been formed in the location of, St Columba Anglican School.
Signature of Parent/Guardian 2*

Powered by Jotform SignClear
By signing here, you expressly consent to receiving these terms and conditions electronically and acknowledge that all other notices or documents required to be given in respect to the terms and conditions may be sent to you by electronic communication. You acknowledge and agree that any agreement formed upon the signing of these terms and conditions has originated from, and is deemed to have been formed in the location of, St Columba Anglican School.
Should be Empty:

Student Exit Form

Student Details

Parent Details

Account Finalisation

Account Details