Student Withdrawal Form

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I have notified my child's school or the district office and have informed them that my child is withdrawing. *

You MUST speak to a live person before your child can withdraw. Please contact your child's school or the district office at 970-842-5176

Yes

Name of individual you spoke to regarding your child's Withdrawal *

Current Brush School Attending *

Head Start/Preschool

Thomson Primary

Beaver Valley Elementary

Brush Middle School

Brush High School

Student's Legal Name *

Student Gender *

Female

Male

Student Date of Birth *

YYYY

Student Grade *

Withdrawal Date *

YYYY

Parent/Guardian Legal Name *

Telephone Contact Number *

Email Address

Forwarding Address *

Please include City, State and Zip Code

Reason for Withdrawal *

Transfer to another Colorado School

Transfer Out of State

Home School

Other:

I have returned all school items to the District Office at 527 Industrial Park Road, Brush CO 80723 *

Please Note you will be charged for any items that are not returned, including chromebooks, chargers, textbooks and other materials.

Yes

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This form was created inside of Brush School District RE2(J). Report Abuse