Enrollment Withdrawal Form

Enrollment Withdrawal Form

We're sad to see you go! Please fill out this form to officially withdraw your student from Berkeley Preparatory Academy.
Student's Full Name*

First NameLast Name
Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade
Reason for Withdrawal*
Last Day of Attendance*

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.Format: (000) 000-0000.
YesNo
New School Name*
New School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YesNoN/A Student is in K-5N/A Summer Break
I understand
I am officially withdrawing this student from Berkeley Preparatory Academy (BPA) for the above reason. Please electronically sign this form below indicating all information on this form is true/correct and you understasnd this agreement to withdraw the above named student from BPA, is binding. *The electronic signature is in accordance with the Esign Act and has the same legal status as a handwritten signature. All parties agree that this agreement may be electronically signed and the electronic signature appearing on this agreement is for the purpose of validity, enforceability, and admissibility. *
Date*

MonthDayYear
To ensure a smooth transition, your child’s new school may email official records requestsdirectly to our Records & Data Systems Administrator:

Ms. Heather Maruschak: Heather.Maruschak@BerkeleyPreparatory.org

Please ask the requesting school to include:
- Student’s full name and date of birth
- Grade level and last day of attendance at BPA
- A contact name, phone number, and return email/fax (if applicable)
Thank you for helping us make this transition as seamless as possible!
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