Monte Vista On-Line Academy NOTIFICATION OF WITHDRAWAL
Email address *
Today’s Date
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Last Attendance Date
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Student’s Full Name *
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Student’s Date of Birth *
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Parent Name *
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Mailing Address *
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City, Zip *
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Parent Cell Number
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Parent Work Number
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*Please indicate reason for withdrawal (Exit Code): *
*Please provide the following if student is transferring to another school or program:
Anticipated Date to Enroll
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Name of New School / Program
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Street Address
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City, State, Zip
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Country (if other than US)
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By clicking below, you acknowledge that this form officially notifies OLA of your intent to enroll with another educational program. *
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