PSAS Withdrawal Form
Please complete a separate form in its entirety for each student.

All books and equipment that have been checked out to your student will need to be returned to the school and an administrator at the building must sign off on a check-out form.
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Student First and Last Name *
Withdrawal Date *
MM
/
DD
/
YYYY
Student Grade *
Student Date of Birth *
MM
/
DD
/
YYYY
Campus Student is Withdrawing From *
School Student Will be Attending (name, phone, address) *
Reason for Withdrawal *
Required
Guardian's First and Last Name *
Guardian's Phone Number *
Guardian's Address *
Guardian's Email Address *
What did you like best about PSAS?
What did you like least about PSAS?
Please rate overall effectiveness of PSAS communication
Poor
Excellent
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Additional information you would like to share with PSAS
Would you like to have a one-on-one conversation with an administrator in regards to your student's withdrawal?
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I hereby authorize the withdrawal of my student from this school, and if transferring, request transfer of all academic and health records to the school listed above. *
By typing your name below, you agree to the above.
Submit
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This form was created inside of Pueblo School for Arts and Sciences.