SLSPA Student Withdrawal Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is to be filled out by the parent/guardian of a student who intends to unenroll from SLSPA. Please note that if this form is completed, and the student is unenrolled, we cannot guarantee their spot at our school should they desire to return.

Email *

Student First Name *

Student Last Name *

Student Date of Birth *

YYYY

Grade: *

Withdrawal Date: *

YYYY

Parent/Guardian Name: *

Telephone: *

Reason for Withdrawal *

Transfer to Another Charter School

Transfer to District School

Transfer to Private School

Transfer Out of State

Home School

Other:

Name of New School: *

School Address (if known):

School Telephone/Fax (if known)

Please check if these apply to your student

My student has an active IEP, and is receiving Special Education services.

My student has a 504 plan.

By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *

In an effort to better improve our school, please feel free to give us feedback on the reason for your student's withdrawal from SPA! Thank you. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Salt Lake School For the Performing Arts. Report Abuse

Forms