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
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Student Last Name
Student First Name
Student's Birth Date
Student's Grade Level
Student's Last Day of School
Transfer student to:
Hawaii Public School
Hawaii Private School
Homeschool (required to complete withdrawal and enroll in your district school )
Out of State/ Out of Country School
DOE Alternative Education Program
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 Phone Number
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).
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