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Yellow Springs Schools - Withdrawal Form
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* Indicates required question
Email
*
Your email
Please enter the last day your child attended or will be attending Yellow Springs Schools.
*
MM
/
DD
/
YYYY
Student Name
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Student's Current Grade
*
Choose
K
1
2
3
4
5
6
7
8
9
10
11
12
Current Address
*
Your answer
New School Name
*
Your answer
New School City, State, Zip Code
*
Your answer
New School District
*
Your answer
Reason for Withdrawal
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
A copy of your responses will be emailed to the address you provided.
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