CRA Student Exit
For our records, please provide the following information.
Student Last Name *
Your answer
Student First Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Current Grade *
Teacher *
Your answer
Last Day at Community Roots Academy *
MM
/
DD
/
YYYY
Student's Street Address *
Your answer
City, State, Zip *
Your answer
Parent First and Last Name *
Your answer
Best form of contact *
Phone Number *
Your answer
E-mail Address *
Your answer
Reason for Student Exit *
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