2022-23 Three Rivers HomeLink Withdrawal Form

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Please fill out the following form if you intend on withdrawing any of your students for the upcoming 2022-23 School Year. If you do not intend to withdraw any of your students, you do not need to fill out this form.

Email *

What day would you like to set as your official withdrawal date?

Parent Name (First and Last Name) *

Mailing Address *

Phone Number *

Student(s) Name(s) who will be withdrawn (include their grade, gender, and date of birth next to each child being withdrawn) *

Will your student be going to a traditional school? *

Yes

If you said yes to the question above, what is the name of the traditional school you intend on enrolling your student? If you said no, put n/a. *

Will your student be going to Independent Homeschool? *

Yes

If you are moving, what is your new address? (put n/a if you aren't moving) *

Is there another reason for withdrawing? If yes, please list reason. *

Is there anything HomeLink could have done to improve your educational experience? *

Please check that you understand if you are withdrawing from HomeLink, you are required to return all library items checked out as well as any technology items. Failure to return items will result in a fine. All items must be returned to HomeLink prior to your enrollment in your new school. If you have already enrolled in your new school, you will need to bring in your materials immediately to the main HomeLink campus. *

I have read and understand the terms of returning library/technology items.

Required

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