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Withdrawal Form

Student Withdrawal Form

Retiro del estudiante

Type of Withdrawal:

Parent-Initiated--parent(s) desires to withdraw student from the school.

Administrative--after repeated contact and/or no response from the family regarding required information of enrollment paperwork, continuation paperwork, or absences, the administration has determined the student will not be returning to the school due to noncompliance or the parent(s) has (have) refused to provide the required information.

Parent-Initiated/de Padre

Administrative (admin explain below)

Today’s Date/Fecha (MM/DD/YYYY)

Withdrawal Effective Date/ Fecha efectiva:

Student’s Name/Nombre de Estudiante:

Date of Birth/Fecha de Nacimiento:

Grade in School/Grado en Escuela:

Parent/Guardian Name/Nombre de Padre/Madre

Student is Enrolled in:

Program(s) Enrolled:

Online School/Escuela en linea

School of Record/ Escuela de Registro

In-Person Enrichment Program/Programa de Enriquecimiento en In-Person

K-5 Online EP/Program de Enriquecimiento en linea K-5

Student is withdrawing from:

Student is withdrawing from:

Online School/Escuela en linea

School of Record/Escuela de Registro

In-Person Enrichment program/Programa de Enriquecimiento en In-Person

K-5 Online EP/Programa de Enriquecimiento en linea K-5

Transferring to/Transferir a:

Private School U.S.A./Escuela Privada EE.UU.

Public School U.S.A./Escuela publica U.S.A.

Private School outside U.S.A./Escuela Privada afuera EE.UU.

Public School outside of U.S.A./Escuela Publica afuera EE.UU.

Home School/Escuela en casa

Dropping Out of School/abandonar la escuela

G.E.D.

Unknown

Name of New School/Nombre de la Nueva Escuela:

School Address/ Dirección de Escuela:

City, State/Province, Zip Code/Ciuadad, Stato o Privincia, Codigo Regional:

School Telephone/Numero de Fono de Escuela:

By signing below, I affirm that I am withdrawing my student from AIAA and forfeiting my student’s place in the face-to-face Enrichment Program (if applicable).

Al firmar a continuación, afirmo que retiraré a mi estudiante de AIAA y perderé el lugar de mi estudiante en el Programa de Enriquecimiento presencial (si aplicable).

If administrative withdrawal, click here and type admin name:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

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Timestamp

Audit

August 25, 2019 9:34 pm -05

Withdrawal Form Uploaded by Nicole Marrone - nicole@aiaandes.org IP 76.111.153.145