Withdrawal and Inter-District Transfer Form
Pupil withdrawing from HSSD or being transferred to a different elementary school will submit this form.  Pupil withdrawals or transfers will be processed within 3 business days of submission of this form.  NOTE:  prior to submitting this form, please be sure to print pertinent pupil information such as report card, attendance report, quick look-up screen, log entries, etc.  

Communications of pupil withdrawals or inter-district transfers will be communicated to Lamers, IT Dept, Student Services, and School Nutrition Dept.  
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電子郵件 *
Is this a WITHDRAWAL  or INTER-DISTRICT TRANSFER? *
If this is a transfer, briefly explain pupil situation.
Date of WITHDRAWAL/TRANSFER?  (Note: the withdrawal date should be the NEXT school day AFTER the last day in school). *
If this is a WITHDRAWAL, has the school received a REQUEST OF RECORDS from the new school?
清除選取的項目
EXIT code *
Pupil LAST NAME (as it appears in the student management system). *
Pupil FIRST NAME (as it appears in the student management system). *
Pupil DATE OF BIRTH *
GRADE level *
Name of the SCHOOL the pupil attends *
NEW SCHOOL name and address (example: HSSD, 2706 Lineville Rd, Green Bay, WI  54313 920-662-7878). *
While attending HSSD, did the pupil reside INSIDE or OUTSIDE of the district boundary? *
At the time  of attending HSSD, did the pupil receive SPECIAL EDUCATION SERVICES? (if yes, provide NEW SCHOOL name, addre *
Did the pupil return their DISTRICT ISSUED TECHNOLOGY *
What action did you take with contacting parent/guardian regarding retrieving the device? Example:  phone call, email, etc. *
NOTES you wish to record regarding the pupil or family.
HSSD employee NAME completing this form (last, first) *
District Site/School *
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