NCPS - Request for Withdrawal
Please fill out the following form for each student. Only an authorized parent/guardian on record can request a withdrawal.
Authorized Parents/Guardian First Name
Your answer
Authorized Parents/Guardian Last Name
Your answer
Authorized Parent/Guardian phone number
Your answer
Authorized Parent/Guardian Email Address
Your answer
Student's Legal First Name
Your answer
Student's Legal Last Name
Your answer
Student's Legal Middle Name
Your answer
Select School Student is Currently Attending
Grade
Address to send last report card and/or other documents
Your answer
City, State, Zip to send last report card and/or other documents
Your answer
Reason for Withdrawal
Your answer
Select appropriate transfer option
Last Day Attending NCPS
MM
/
DD
/
YYYY
Student Record & Confidential Information Release
Record Released (Check all that apply)
Required
Name of school/organization obtaining records
Your answer
School/organization Address
Your answer
School/organization City, State, Zip
Your answer
Submit
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