Withdrawal Questionnaire | District | Legacy Traditional Schools

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Withdrawal Year

Student Name*

First Last

Grade

Teacher*

Campus*

What is the name of the next school your student will be enrolled in?*

Reason for Leaving

Please Note: You may only choose ONE option below*

Reason for Leaving: Academics*

Reason for Leaving: Attendance*

Reason for Leaving: Household Move*

Reason for Leaving: Personnel*

Reason for Leaving: Policies*

Reason for Leaving: Preference*

Reason for Leaving: Special Education*

Reason for Leaving: Transfer to Another Legacy Traditional School*

Reason for Leaving: Transportation*

Reason for Leaving: Miscellaneous*

Will child be enrolled in another school?*

Name of school to send records to:

Does child have any medication(s) in the Health Office to be picked up?

Student’s expected Last Day of Attendance:*

Parent Signature*

Date*