Ka ‘Ohā  - Program Withdrawal Form
Please complete this form to withdraw your student from the Ka ‘Ohā program.  If you have any questions or concerns, please email our office at kaoharecords@kalo.org .

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Student Information
Student Last Name *
Student First Name *
Student's Birth Date *
Student's Grade Level *
Student's Last Day of School *
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Transfer student to: *
Name of New School (If withdrawing to home school please name your district school here that you are required to enroll with) *
Mailing Address of New School *
Parent/ Guardian Information
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Address *
Parent/Guardian Phone Number *
Authorization
I hereby grant permission for Kanu o ka Aina New Century Public Charter School to forward school records upon the request of the receiving school (Parent Name in this box indicates signature and agreement). *
Additional Comments or Feedback
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