Thomas Jefferson Withdrawal Form
Please fill out the withdrawal form with all of the following information:
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Grade *
Student ID (Lunch Number)
Your answer
Reason for Withdrawal *
Your answer
Last School Date in Attendance (MM/DD/YYYY) *
MM
/
DD
/
YYYY
New School
Please fill out the following information regarding the new school your student will be attending.
Name of New School
Please fill out the following information regarding the new school your student will be attending.
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Forwarding Address
Please fill out the following the information regarding a forwarding address for your student.
Street Address
Your answer
City, State, Zip
Your answer
Electronic Signature
The electronic signature below and its related fields are treated by Falls Church City Public Schools like a physical handwritten signature on a paper form. I affirm that all the information provided is true and correct to the best of my knowledge.
Electronic Signature *
Your answer
Parent Email Address *
Your answer
Submit
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