Learner Withdrawal Form

Withdrawal Form & Family Exit Survey

We value the time we have spent with your child and we thank you for the privilege of allowing us to be a part of their education. The sole purpose of this survey is to find ways to better serve the families in our community. Please complete the following survey to the best of your ability and be as candid as possible. All responses are confidential. We thank you in advance, and please let us know if we can assist you in any way in the future.

Family Information
Parent/Guardian 1
Name*

First NameLast Name
Relation to learner(s)*

FatherMotherGuardianOther
Email*
Parent/Guardian 2
Name

First NameLast Name
Relation to learner(s)

FatherMotherGuardianOther
Email
Learners
Number of learners whom you wish to withdraw from Dayspring Academy*
Learner 1
Learner's Name*

First NameLast Name
Gender*

MaleFemale
Grade*
Effective withdrawal date*

MonthDayYear
New school's name*
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school

YesNoN/A
Learner 2
Learner's Name*

First NameLast Name
Gender*

MaleFemale
Grade*
Effective withdrawal date*

MonthDayYear
New school's name*
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school

YesNoN/A
Learner 3
Learner's Name*

First NameLast Name
Gender*

MaleFemale
Grade*
Effective withdrawal date*

MonthDayYear
New school's name*
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school

YesNoN/A
Learner 4
Learner's Name*

First NameLast Name
Gender*

MaleFemale
Grade*
Effective withdrawal date*

MonthDayYear
New school's name*
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school

YesNoN/A
Learner 5
Learner's Name*

First NameLast Name
Gender*

YesNo
Grade*
Effective withdrawal date*

MonthDayYear
New school's name*
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school

YesNoN/A
What is the reason for which your family is leaving Dayspring? (please select all that apply)*

RelocationTransferring to another Pasco County public schoolTransferring to private schoolTransferring to online programWithdrawing to homeschool (you must open a Home Education program through the Pasco County School District before being officially withdrawn)Transportation issueDissatisfaction with academic programDissatisfaction with leadership/administrationClass size too smallClass size too largeLack of curricular activitiesChild's personal/emotional needs not metChild's friends/siblings at another schoolLooking for different experience/atmosphere for my childOther
Comments

Quality Rating
Academics

Dayspring Academy is doing an excellent job in teaching

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
Reading
Writing
English / Language Arts
Mathematics
Sciences
Humanities
Foreign Language
Art
Theatre
Music
Dance
Physical Education
Technology
Study Skills / Habits

Resources

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
My child(ren) received a quality education at Dayspring
My child(ren) have access to a variety of learning resources
Dayspring's class sizes contribute to the overall quality of the program
Dayspring's curricular programs are broad enough to meet the educational needs of all learners in the community
Relationships between teachers and parents are strong
I feel the environment at Dayspring is safe for learners
I feel comfortable approaching the front office for assistance
Administrative leadership is effective and organized
Dayspring's facilities are clean and well maintained

Social

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
Learners show respect for one another
Dayspring's discipline policies are fair and effective
Dayspring provides learners and teachers with a safe and orderly environment
Teachers and administrators at Dayspring show genuine concern for the well-being of learners
Discipline problems are competently handled
Dayspring tries to bring out the best in each learner

Communication

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
Parents feel welcome at Dayspring
Communication about Dayspring's programs and operations are regular and informative
Communication platforms are useful and contain the necessary information about operations and programs
Communications were clear on how to contact teachers and administrators
Dayspring addresses parent concerns seriously and quickly

Comments
Thank you for providing this information to us. We wish you and your family all the best on your educational journey.
Your comments are important to us:

Submission
Withdrawal is only valid when you have received confirmation from Dayspring Academy.

Please do not hesitate in contacting our Student Services department if you have any questions (studentservices@dayspringacademy.org).
Should be Empty:

Withdrawal Form & Family Exit Survey

Parent/Guardian 1

Parent/Guardian 2

Learners

Learner 1

Learner 2

Learner 3

Learner 4

Learner 5