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Rocky River City Schools Withdrawal Checklist
Please complete this form online and then print and return it to your school office. Full withdrawal from the district will not be complete until the withdrawal process is complete.
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* Indicates required question
*
Your answer
Grade
*
Pre K
1
2
3
4
5
6
7
8
9
10
11
12
12+
Student Birthday
*
MM
/
DD
/
YYYY
New Address
*
Your answer
Parent email
*
Your answer
Parent phone number
*
Your answer
Name and Address of New School
*
Your answer
Please choose one of the following:
My child will be enrolled in
Ohio Public School
Ohio Private School
Out of State School
Out of the Country
Online School
I intend to home educate my child and will notify the pupil services department 440.356.6000
Other:
Clear selection
Reason for Withdrawal
*
Entire Family Moving
Student moving to live with other parent/ guardian
Student to attend private school
Student is 18 years old and is electing to work
Other:
Last day of attendance
*
MM
/
DD
/
YYYY
I understand that if a gap in attendance exists between the last day of attendance in the RRCSD and the date of enrollment at the new school, these days are considered unexcused absences and may lead to a truancy referral.
*
I understand: Parent Signature _______________________________________
If I have a lunch account balance please:
*
Transfer funds to another student account (submit name to office)
Refund the money to the address above
Donate refund to students in need
Other:
THIS MUST BE PRINTED. See office if you need assistance. Students must take this form to all teachers for clearance
Teachers will collect textbooks and the teacher/advisor signature indicates the above named student has fulfilled all responsibilities associated with each class, team or activity.
Teacher 1
Teacher 2
Teacher 3
Teacher 4
Teacher 5
Teacher 6
Period
Course
Book/ Materials Returned
Quarter grade upon withdrawal
Teacher signature
Teacher Name
Teacher 1
Teacher 2
Teacher 3
Teacher 4
Teacher 5
Teacher 6
Period
Course
Book/ Materials Returned
Quarter grade upon withdrawal
Teacher signature
Teacher Name
Athletics and Activities
Activity and Athletic Event
Comments
Advisor Signature
___________________
____________________
_______________________________
Activity and Athletic Event
Comments
Advisor Signature
___________________
____________________
_______________________________
Main office
Amount __________
Yes
No
Fee(s) due
Locker Cleaned
Lunch Account Balance
Books Due to Library
Library Fine
Amount __________
Yes
No
Fee(s) due
Locker Cleaned
Lunch Account Balance
Books Due to Library
Library Fine
Counselor Signature
Your answer
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