Student Withdrawal Form-Vintage Hills

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Hello Vintage Hills Elementary School families:

Please complete this form if your student is exiting Pleasanton Unified School District.

You must submit one form for each child that you are requesting to exit PUSD.

Please return any borrowed computers, library books or other school items to the front office on or before your last day of school.

Email *

Student Name: *

Student ID# (if known)

Student's Teacher Name *

Last Day (Date) at Vintage Hills *

YYYY

Reason For Withdrawal *

Transfer to private school

Transfer to another district in California

Transfer out of state

Transfer outside of USA

Transfer to Homeschool Program

New school name, street address, city and state AND phone number *

Parent/Guardian Name *

Thank you for letting PUSD know that you have enrolled your child in another school district or your family no longer resides in Pleasanton. As of the date provided above, your student will be unenrolled from PUSD. Please know that if you return to the Pleasanton Unified School District, Board Policy 5116: School Attendance Boundaries may dictate the placement of your student. Enrollment in your student’s resident school is not guaranteed and places in classrooms or programs will not be held.

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A copy of your responses will be emailed to the address you provided.

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