SUGAR CREEK CHARTER SCHOOL: Student Withdrawal Form

SUGAR CREEK CHARTER SCHOOL

Student Withdrawal Form
To withdraw your student from Sugar Creek Charter School, the following form must be completed. This form notifies the registrar of your intent to withdraw your student and provides Sugar Creek Charter School the authorization to release student records to the transferring school.
Student Name (First and Last)*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Telephone #*
Cell Phone #*
K-8 Homeroom Teacher's Name
Student's Current Grade*
Reason(s) for leaving: (Please provide detailed explanation)*
Transferring School Information (For the transfer of student records.) *

Name of the School

School Address

CityState / Province

Postal / Zip Code
School's Telephone Phone #*
School's Fax #*
Type of School*
Effective Date of Withdrawal*

MonthDayYear
Date
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Government or State Issued Identification (Verify Signature)*

Cancelof
Should be Empty: