Student Withdrawal Form
I have notified my child's school or the district office and have informed them that my child is withdrawing. *
You MUST speak to a live person before your child can withdraw. Please contact your child's school or the district office at 970-842-5176
Name of individual you spoke to regarding your child's Withdrawal *
Current Brush School Attending *
Student's Legal Name *
Student Gender *
Student Date of Birth *
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Student Grade *
Withdrawal Date *
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Parent/Guardian Legal Name *
Telephone Contact Number *
Email Address
Forwarding Address *
Please include City, State and Zip Code
Reason for Withdrawal *
I have returned all school items to the District Office at 527 Industrial Park Road, Brush CO 80723 *
Please Note you will be charged for any items that are not returned, including chromebooks, chargers, textbooks and other materials.
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This form was created inside of Brush School District RE2(J). Report Abuse