AWSSC Enrollment/Withdrawal Form
Email *
STN: *
DOB: *
MM
/
DD
/
YYYY
Grade: *
Student Name: *
Parent/Guardian: *
Address: *
City: *
ZIP: *
Phone: *
Primary Eligibility: *
Secondary Eligibility: *
Enrollment Information
Transfer within AWSSC to
Transfer within AWSSC from:
Additional Comments: Please list new teacher of record and previous teacher of record
Initial Eligibility Case Conference Date
MM
/
DD
/
YYYY
Move-in from (School/Corporation/Date):
Withdrawal Information
Date of transfer, graduation, move, etc.:
MM
/
DD
/
YYYY
Transfer within AWSSC to:
Transfer within AWSSC from:
Additional Comments: Please list new teacher of record and previous teacher of record
Completed by: *
Submit
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