Notification of Student Relocation

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Upon our receipt of a records request form, all items will be sent with 1 business day. The request can be submitted via fax to (804) 733-2665, e-mailed to Dr. Bhatt at Sbhatt@pgs.k12.va.us or Mrs. Johnson at Jjohnson@pgs.k12.va.us. Students must return all school property (computer, hotspot, library books) and pay any outstanding fines, before a student can be cleared. Your child will remain enrolled in our school until a request is received from the new school.

Student name

Parent e-mail address (A copy of this form will be e-mailed to you).

Current Grade

Grade 8

Grade 9

Clear selection

Student ID #

Please select reason for withdrawing your student.

Please select which of the following are applicable, if any.

Special Education (My child has been found eligible and is receiving specialized education services under an IEP)

Section 504 (My child has a disability and was found eligible for services under Section 504)

English Language Learner

Where are you planning to relocate to (city, state or military installation)?

If known, what school will your son/daughter be attending?

If known, please provide phone number for receiving school.

What will be the last date in which your child will be in attendance in Prince George County? We will provide your student with a withdrawal form and collect his/her Chromebook on this date.

YYYY

Parent/Guardian Forwarding Address:

Parent Phone Number?

Submit

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