Pine Grove Middle Withdraw/Transfer Out Request
The survey will take approximately 6 minutes to complete. This form is used by Parents to officially withdraw their students from Pine Grove Middle School. Upon the completion of this form a transfer/withdrawal packet will be provided within 48 hours.
Email *

Provide Student's Full Name *

Students Date of Birth (MM/DD/YYY)
 *
MM
/
DD
/
YYYY
Students Current Grade Level
 *
Current Address
 *
If Moving New Address
 *
New School Student will be Attending
 *
School Guidance/Records Email address where the tranfer packet should to be sent.  *
Alternative Program
*

Special Services Your Child Receives
 *
Parent/Guardian email *
Parent/Guardian phone
 *
Parent/Guardian Name (By inputting name parent is authorizing withdrawal)
 *
Date Student Should be Withdrawn
 *
MM
/
DD
/
YYYY
I agree to return all Baltimore County Public School property, that includes, any and all devices, instuments and/or books to Pine Grove Middle School.  *
Required
I certify that I am the parent and legal guardian of the student, and I will ensure that the device belonging to Baltimore County Public Schools is returned prior to withdrawal of student. 

I hereby authorize Baltimore County Public Schools to release the student record(s) identified above. I understand that the recipient of the student record(s) will use the record(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of the Educational Rights and Privacy Act, 20 U.S.C. 123g
 *
A copy of your responses will be emailed to the address you provided.
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