Pre-K/EC Student Withdrawal Form
This form needs to be completed when a student is no longer attending.
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Email *
Reason for completing this form: *
Student's Full Name *
Last, First, Middle
Student's Date of Birth *
SIS Number of student (this is a nine digit state ID - it should be listed in student information system of school) *
Building attended *
Session attended *
Does the student have an IEP? *
Date Dropped *
Be sure that drop date is consistent with the school secretary.
Reason for withdrawal *
If reason for withdrawal is not listed or you know the name of the program the child is now attending, please explain *
If moving to different program within the district, please state that information (ex. transfer from Ragan AM to Keel AM)
Person completing this form *
First and last name
A copy of your responses will be emailed to the address you provided.
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