AWSSC Enrollment/Withdrawal Form
Email address *
STN: *
Your answer
DOB: *
MM
/
DD
/
YYYY
Grade: *
Student Name: *
Your answer
Parent/Guardian: *
Your answer
Address: *
Your answer
City: *
Your answer
ZIP: *
Your answer
Phone: *
Your answer
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
Your answer
Initial Eligibility Case Conference Date
MM
/
DD
/
YYYY
Move-in from (School/Corporation/Date):
Your answer
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
Your answer
Completed by: *
Your answer
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