SHS Withdrawal Form (one form per student)
Please complete this form if you are withdrawing your student(s) from Steilacoom High School.  We ask that you complete one form for each student withdrawing from SHS.

For specific questions regarding your child's withdrawal, please contact us at (253) 983-2300 or steilacoomhsoffice@steilacoom.k12.wa.us.

Thank you!


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Email *
Student's Name in Skyward (one form per student) *
Last Day of School / Withdrawal Date *
MM
/
DD
/
YYYY
Student's Grade Level *
Parent/Guardian's Name(s) & phone number: *
Reason for Withdrawal *
If moving, please provide the name of your child's new school, including city & state:
Please check the following that need to be returned to the SHS office.  
*Check with the SHS bookkeeper for outstanding fines/fees; items not returned prior to withdrawal will be added.
 *
Required
I understand it is the responsibility of the student to work with their teacher(s) to receive withdrawal grades prior to their last day. Please have your child stop by the Registrar's office to pick up their check out form to take to each class. This information will be used when enrolling into the next school. *
Required
If there is a balance remaining on your student's food service account would like a refund, or would you like to donate the balance to the school food account? *
Forwarding address for refund (All fines/fees need to be paid before a refund is issued):
Today's Date *
MM
/
DD
/
YYYY
Returning school materials or paying fines:
Chromebook/school materials:  Stefani James 253.983.2322 or sjames@steilacoom.k12.wa.us
Paying outstanding fines/fees: Beth Agnew 253.983.2305 or https://www.steilacoom.k12.wa.us/site/Default.aspx?PageID=3781
A copy of your responses will be emailed to the address you provided.
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