Mary Ellen Henderson Withdrawal Form
Please note that this is a Withdrawal Form for Mary Ellen Henderson Middle School only. Mt. Daniel Elementary, Thomas Jefferson Elementary, and George Mason High Schools will all have different Withdrawal procedures. Please contact their registrars for more information.

THIS IS NOT A RECORDS REQUEST FORM. DO NOT PROVIDE RECORDS NEEDED ON THIS FORM. If you need to submit a records request, please select the "Records Request" form from the MEH main web site. Records will not be provided if filled out on this form.

Please fill out the withdrawal form with all of the following information:
Student First Name *
Student Last Name *
Grade *
Reason for Withdrawal *
"Moving to Argentina", "Moving to Arlington, VA", "Transferring to private school"
Last School Date in Attendance (MM/DD/YYYY) *
New School
Please fill out the following information regarding the new school your student will be attending.
Name of New School
School Street Address
School City, State, Zip
Forwarding Address
Please fill out the following the information regarding a forwarding address for your student.
Street Address
City, State, Zip
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 *
Parent Email Address *
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