LHA Withdrawal Form

Withdrawal Form
Home Educator

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this a new address?
School Year
Student Name(s)
Transfer to
Name of School/Association
Reason
ACKNOWLEDGEMENT. By clicking submit, I acknowledge the following: RECORD KEEPING: I understand that it is my responsibility to maintain ALL educational records including transcripts, these include:(1) a plan book, diary, or other record indicating subjects taught and activities in which the student and parent-teacher engage (2) a portfolio of samples of the student’s academic work (3) a semiannual progress report including attendance records and individualized documentation of the student’s academic progress in each of the basic instructional areas specified in the law. STATEMENT OF COMPLIANCE: I have fulfilled the requirements for home schooling to date. WITHDRAWING: I am officially withdrawing my child from Lowcountry Homeschool Association.
Effective Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: