Withdrawal Request

School Year

School Name

Student First Name

Student Middle Name

Student Last Name

Student ID

Date of Birth

Student Grade

Anticipated Last Day at School

Reason for Withdrawn

Other Reason for Withdrawn

Student Address Country

Student Address Line 1

Student Address Line 2

Student Address City

Student Address State

Student Address Zip

New School's Information

New School's Name

New School's Address Country

New School's Address Line 1

New School's Address Line 2

New School's Address City

New School's Address State

New School's Address Zip

Withdrawing Adult's Information

Withdrawing Adult's First Name

Withdrawing Adult's Last Name

Withdrawing Adult's Relationship

Withdrawing Adult's Contact Number

Withdrawing Adult's Email

Acknowledgements

APS Board reserves the right to charge students a reasonable fee for the restitution of lost, damaged, or abused property, as specified in this policy.

Have completed the GaDoE Homeschool Declaration of Intent form and am uploading to this withdrawal request.

To withdraw my minor student (age 16 or 17) from school, I must meet with school staff prior to this withdrawal becoming effective. I also understand that other educational opportunities for my student exist, including a general educational development (GED) diploma. I understand that there are consequences for not receiving a high school diploma or the equivalent, including lower lifetime earnings, fewer available jobs, and an inability to pursue higher educational opportunities such as college.

Withdrawing Adult's Signature

Attach Photo ID / Attach GaDoE Completed Home School FormYou can upload a maximum of 2 files, each up to 25MB. Supported files include image, .pdf.

New School's Information

Withdrawing Adult's Information

Acknowledgements

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