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MCHS Student Withdrawal Form
Complete withdrawal form to start withdraw process for your student
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* Indicates required question
Email
*
Your email
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Student Withdrawal Date
*
MM
/
DD
/
YYYY
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Student Grade
*
9
10
11
12
13
Required
Does student have a IEP or 504 Plan?
*
IEP
504 Plan
No
Don't Know
ML (multilingual learner) student?
*
Yes
No
Don't Know
Reason for Withdrawal?
*
Transfer to New School/Family moving
Home School program
Pursuing GED
Drop
Other:
Is the student transferring to a school outside of Illinois?
*
Yes
No
What is the name of the school student will be transferring to?
*
Your answer
Do you authorize records to be released to your child's new school?
*
Yes
No
Other:
Withdrawal Requested By
*
Parent/Guardian
Student Over Age 18
MCHS Staff
Other:
School materials student will be returning
*
Chromebook
Chromebook Charger
Textbooks
Library Books
Athletic uniform and/or equipment
School ID
Other:
Required
Date school materials will be returned (if applicable)
*
MM
/
DD
/
YYYY
Date student fees will be paid (if applicable)
*
MM
/
DD
/
YYYY
Please provide Forwarding address
*
Your answer
Comments
Your answer
A copy of your responses will be emailed to the address you provided.
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