XLT Programs Schedule Change Request 20-21
please use this form to request an attendance change for XLT and Eagle Care.
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Email *
Child's Full Name *
First and Last
XLT Site *
choose the site where the child attends XLT
Current Schedule *
Choose the schedule that you are currently being billed for
Required
New Schedule *
select the schedule you would like to change to, or choose withdraw
Required
Reason for change or withdraw *
please state your reason for changing your schedule
Parent/Guardian Full Name *
a schedule change can only be requested by the parent/guardian
Parent/Guardian Last 4 of Social Security Number *
Parent/Guardian Email address *
please enter an email address for a confirmation
Acknowledgement *
please check the box below
Required
Enter the Effective Date of Change *
the effective date of change MUST be  at least 1 month from today's date, we do not PRORATE for mid month schedule changes, start dates or end dates of care.  Changes must take place on the last or first day of the month.
Do you have an automatic payment set up in SchoolPay? *
Does your payment need to be cancelled or adjusted? *
A copy of your responses will be emailed to the address you provided.
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