NW Islamic School
Student Withdrawal Form
We are sorry to see your family leave NW Islamic School. This form is used to formally process a student withdrawal. Please complete all sections to ensure a smooth transition for your child.
Section 1: Student Information
Student's Full Name:
Grade / Class:
Date of Birth:
-
Month
-
Day
Year
Date
Date of Enrolment:
-
Month
-
Day
Year
Date
Requested Last Day of Attendance:
-
Month
-
Day
Year
Date
Section 2: Parent / Guardian Information
Full Name:
Relationship to Student:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Current Address:
Section 3: Reason for Withdrawal
Please select all that apply:
Family relocation
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Transferring to another school
Financial reasons
Personal / family reasons
Dissatisfaction with school (please specify below)
Other (please specify):
Name of new school (if applicable):
Additional comments or feedback:
Section 4: Transfer of Records
Please indicate if you require the following records to be transferred:
Academic transcripts and report cards
Immunization records
Individual Program Plan (IPP)
Other:
Transfer records to (school name and address):
Section 5: Outstanding Obligations
All outstanding tuition fees must be settled before withdrawal is processed.
All school property (textbooks, library books, uniforms, devices) must be returned.
Any outstanding fee balances will be communicated by the school office.
School Property Returned:
Yes
No
Not Applicable
Outstanding Fees Settled:
Yes
No
Not Applicable
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Section 6: Exit Feedback (Optional)
We value your feedback. Is there anything you would like to share about your family's experience at NWIS?
Section 7: Declaration & Signature
I confirm that I wish to withdraw my child from NW Islamic School. I understand that this withdrawal is effective as of the last day of attendance indicated above, and that all outstanding obligations must be fulfilled.
Parent / Guardian Signature:
Date:
-
Month
-
Day
Year
Date
For Office Use Only
Withdrawal Processed By:
Date Processed:
-
Month
-
Day
Year
Date
Records Transferred:
Yes
No
Date:
-
Month
-
Day
Year
Date
Outstanding Balance: $
Balance Cleared:
Yes
No
Notes:
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