George Mason High School Withdrawal Form
This is a withdrawal form for George Mason High School only. Mt. Daniel Elementary, Thomas Jefferson Elementary, and Mary Ellen Henderson Middle School all have its own withdrawal form and procedures. Please contact their registrars for more information
(MEH - avilak@fccps.org, TJ - newmand@fccps.org, MD - smileys@fccps.org, JT - hambergerr@fccps.org)

THIS FORM SHOULD NOT BE COMPLETED MORE THAN 1 MONTH IN ADVANCE OF YOUR STUDENTS WITHDRAWAL DATE.

Please fill out the withdrawal form with all of the following information:

FULL LEGAL NAME OF PARENT/LEGAL GUARDIAN COMPLETING THIS FORM: *
Your answer
WITHDRAWING STUDENT FULL LEGAL NAME: *
Your answer
STUDENT NUMBER: *
Same as his/her lunch number
Your answer
STUDENTS CURRENT GRADE LEVEL (if summer, last grade level completed): *
REASON FOR TRANSFER: *
Your answer
LAST SCHOOL DATE IN ATTENDANCE: *
MM
/
DD
/
YYYY
NEW SCHOOL NAME: *
Your answer
SCHOOL ADDRESS - STREET (Line 1): *
Your answer
SCHOOL ADDRESS - CITY, STATE/COUNTRY, ZIP (Line 3): *
Your answer
NEW SCHOOL PHONE: *
###-###-####
Your answer
NEW SCHOOL REGISTRAR / COUNSELING SECRETARY / COUNSELOR EMAIL: *
Registrar/Counseling Secretary preferred, but new counselor okay if others unavailable.
Your answer
WOULD YOU LIKE THIS STUDENTS FINAL, OFFICIAL TRANSCRIPT SENT TO THE EMAIL PROVIDED ABOVE? *
​*PLEASE NOTE THAT DUE TO STAFFING CHANGES, THE REGISTRAR'S OFFICE WILL BE CLOSED DURING THE MONTH OF JULY. SUBMISSIONS WILL NOT BE ADDRESSED UNTIL AUGUST 2018. // (If mid-semester, the registrar will include withdrawal grades, as well)
I ACKNOWLEDGE THAT IF ANY FURTHER RECORDS BESIDES THE TRANSCRIPT IS NEEDED, I WILL COMPLETE THE RECORDS REQUEST FORM ON THE GMHS COUNSELING WEBPAGE OR EMAIL THE GMHS REGISTRAR AT BIRDB@FCCPS.ORG. I UNDERSTAND THAT NO FURTHER RECORDS WILL BE SENT IF NOT FORMALLY REQUESTED. *
Required
NEW SCHOOL TYPE: *
Please check ALL that apply
Required
FAMILY FORWARDING ADDRESS - NAME (Line 1): *
Your answer
FAMILY FORWARDING ADDRESS - STREET (Line 2): *
Your answer
FAMILY FORWARDING ADDRESS - CITY, STATE/COUNTRY, ZIP (Line 3): *
Your answer
FAMILY FORWARDING PHONE:
Your answer
FAMILY FORWARDING EMAIL: *
Your answer
WOULD YOU LIKE THIS STUDENTS FINAL, UNOFFICIAL TRANSCRIPT SENT TO THE FAMILY FORWARDING EMAIL PROVIDED ABOVE? *
​*PLEASE NOTE THAT DUE TO STAFFING CHANGES, THE REGISTRAR'S OFFICE WILL BE CLOSED DURING THE MONTH OF JULY. SUBMISSIONS WILL NOT BE ADDRESSED UNTIL AUGUST 2018. // (If mid-semester, the registrar will include withdrawal grades, as well)
I ACKNOWLEDGE THAT IF ANY FURTHER RECORDS BESIDES THE TRANSCRIPT IS WANTED, I WILL COMPLETE THE RECORDS REQUEST FORM ON THE GMHS COUNSELING WEBPAGE OR EMAIL THE GMHS REGISTRAR AT BIRDB@FCCPS.ORG. I UNDERSTAND THAT NO FURTHER RECORDS WILL BE SENT IF NOT FORMALLY REQUESTED. *
Required
MOVE DATE OUT OF FALLS CHURCH CITY (if applicable):
MM
/
DD
/
YYYY
DID YOU ORDER A YEARBOOK FOR THE ABOVE STUDENT? *
METHOD OF DELIVERY: *
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