Public Schools of Brookline Withdrawal Form
Parents/Guardians of all students withdrawing from the Public Schools of Brookline (PSB) must complete this form and report where they will be next enrolled. By completing and signing this form you acknowledge that your student will be withdrawn from PSB. Your student's temporary record, which is all material other than your official transcript, will be destroyed no later than seven years after you withdraw from the school system.

If your student is withdrawing from PSB and plans to return, you will be required to complete the enrollment process upon the student's return to Brookline. For more information regarding re-enrollment, please see: www.brookline.k12.ma.us/enroll
Email address *
Student Name *
Your answer
Student's Date Of Birth *
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DD
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YYYY
Current Address *
Your answer
Effective Date of Withdrawal *
This should be the final date your student will be attending class
MM
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DD
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YYYY
Current PSB School *
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