Request for Removal from Empower Online  Program
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Student's First Name *
Student's Last Name *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Student's Grade Level for 20-21 school year: *
I am requesting that my student be removed from the Empower Online Program for the 2020-2021 school year. I understand by making this request that my child will return to face-to-face learning at school when it is in session. (Type first and last name of parent who's making the request). * *
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