Withdrawel Notice

Withdrawal Notice

Name of Person Completing Form
Parent and Student Information
Is the student moving to a new address? *
Withdrawal Information
Name and Address of New School
Special Education Services
Important

If the student being withdrawn is receiving Special Education services, please note the following and mark accordingly.

This student has
Special Education Services
Forwarding Records

Student educational records will be forwarded to the receiving school upon written request.

Electronic Signature*

By electronically signing this document, I am attesting that all of the information I have provided is accurate and correct to the best of my knowledge and is intended to serve as my official signature. The Electronic Signatures in Global National Commerce Act, 15 U.S.C. § 7001, redefines a traditional signature as: (a) In General, Notwithstanding any statute, regulation, or other rule of law (other than this subchapter and subchapter II of this chapter), with respect to any transaction in or affecting interstate or foreign commerce-(1) a signature, contract, or other record relating to such transaction may not be denied legal effect, validity, or enforceability solely because electronic signature or electronic record was used in its formation.

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