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Withdrawal Form During COVID-19 Closure
This form should be completed by the legal parent/guardian of a child who needs to withdraw from Lee County Schools during the state-wide COVID-19 school closure.
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* Indicates required question
Email
*
Your email
Student's Legal Name:
*
Please enter the student's legal name exactly as it appears on their birth certificate.
Your answer
Student's Home Address:
*
Your answer
Student's Primary Phone Number:
*
The phone number listed here will receive automated contacts from Lee County Schools.
Your answer
Birthdate:
*
MM
/
DD
/
YYYY
Student's Current Grade:
*
Choose
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Next School Name:
*
Your answer
Next School Address:
*
Your answer
Next School Phone Number:
*
Your answer
Next School Fax Number (if available):
Your answer
Has student been served in any of the following programs?
Academically Gifted
Learning Disabilities
Hearing Impaired
LEP
Speech/Language
Title 1 Reading
504
Mother's Legal Name:
*
Your answer
Mother's Primary Phone Number:
*
Your answer
Father's Legal Name:
*
Your answer
Father's Primary Phone Number:
*
Your answer
Form Completed by:
*
Your answer
Relationship to Student:
*
Your answer
Today's Date:
*
MM
/
DD
/
YYYY
Send me a copy of my responses.
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