學生休學申請單 Student Withdrawal Form
Please notify the school at
of your withdrawal intent before filling out the form. DO NOT DISTRIBUTE this form to others on your own! Your application will be processed once we receive your withdrawal submission. Refund cheque will be sent out 6-8 weeks after it is processed. Thank you.
~Tzu Chi Academy Seattle Admin Team
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目前就讀年級 Current Class Name
請選擇您孩子目前的班級。 如果學校尚未分班，請填寫上年度就讀班級。Please choose your child's current class. If school has not started, use the previous year class name.
學生中文姓名 Student's Chinese Name
Fill in the English name if your student does not have a Chinese name
學生英文姓名 Student's English Name
退款支票title姓名 Refund Check Title
退款支票上的title姓名。 支票只能開給 ORIGINAL ISSUER。 請用英文姓名。 Please write the name you wish to be on the refund check. The check can only be made out to the ORIGINAL ISSUER, English only!
支票寄送地址 Refund Mailing Address
這是您希望將退款支票發送到的地址。 它不必是您的住家地址。This is the address you wish the refund check to be sent to. It does not have to be your home address.
家長或監護人Email Parent/Guardian Email
家長或監護人電話 Parent/Guardian Phone Number
休學開始日期 Withdrawal Starting Date
休學原因 Reason for Withdrawal
I hereby give Tzu Chi Academy Seattle permission to start the withdrawal process for my child.
Please type your FULL NAME in English in acknowledgement. This allows Tzu Chi Academy Seattle to formally start the withdrawal process for your child. I understand that by typing my name and clicking on "submit", I am electronically signing this document. For parents & legal guardians only.
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