Vision Charter Academy Withdrawal Form
All Questions must be answered to exit your Learner from VCA. Failure to complete the exit form could flag your child as Truant or a dropout in the system.
Email address *
Full Name of Learner
* Required
Your answer
Mailing Address
* Required
Your answer
City
* Required
Your answer
State
* Required
Your answer
Zip code
* Required
Your answer
Name of Parent/ Guardian
* Required
Your answer
Telephone number with area Code
* Required
Your answer
Current Grade Level
* Required
Reason for Withdrawal (exit code):
* Required
*Please Provide the following information if the Student is transferring to another school or program.
Name of New School/Program - Address - City - State - Zip Code
* Required
Your answer
Country (If other than the US):
Your answer
Anticipated last date of attendance at VCA school:
* Required
Your answer
First Scheduled date of attendance in new educational program:
* Required
Your answer
Future Plans: All of us at VCA care about you and supporting your future goals. Please share with us your plans for after graduation. If you will be attending college or technical school, please provide us with the name of the school and location.
Your answer
If you will be entering the military, please provide the name of the branch:
Your answer
If you will be entering the workforce, please indicate what kind of work you will be doing:
Your answer
May we contact you in the future?
* Required
If you answered yes, please provide us with the best contact information: Phone number, email address, etc
Your answer
Family Satisfaction - Please express your over all level of satisfaction with the VCA.
* Required
How did VCA help your learner? Check all that apply
If you checked other, please share with us how participating in this school has benefited your learner:
Your answer
Digital Signature:
I understand that by completing this form I am exiting my learner from Vision Charter Academy. I authorize the completion of this exit via my digital signature below.
Learner's Typed Signature
* Required
Your answer
Date
* Required
Your answer
Parent/Guardian typed signature :
* Required
Your answer
Date
* Required
Your answer
Additional Comments:
Your answer
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