Student Withdrawal Request Form

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Use this form to complete student withdrawals. Note: Only the parent(s) the registered the student can withdraw them.

Use este formulario para completar los retiros de estudiantes. Nota: Solo los padres que registraron el estudiante pueden retirarlos.

Email *

Student Number *

Student First Name *

Student Last Name *

Student Date of Birth *

Registering Parent First Name

Registering Parent Last Name *

Mailing Address *

Registering Parent Contact Number *

Do you have a Dekalb County School Chromebook, textbook, or library book you need to return? *

Yes ( I need to schedule an appointment to bring the equipment to the school)

Reason for Student withdrawal *

Moving to another school within DeKalb County School District

Moving to another Georgia school district

Moving out of state

Moving to Attend homeschool

Moving out of the country

Other

Required

What is the name, and the city and state of the new school your student will be attending *

I certify that I am the student's legal parent/guardian and give Peachtree Charter Middle School my permission to withdraw my child for the school year to attend anther school. I understand that all records will be held until textbooks, chrome books, and other school items are returned. It is my responsibility to make sure these items are returned to the school. I have contacted the school to request a date to return all items in my possession. *

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