Norfolk County Agricultural High School Withdrawal Request
Completion of this form will prompt the formal withdrawal process. You will be contact by your student's Guidance Counselor to complete the process (or the Admin. Assistant to Student Services in the summer).

Lee Hoegler - Last Names A-F
Joe Huff - Last Names G-M
Myles McPartland - Last Names N-Z
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Email *
Student's Last Name *
Student's First Name *
Current Grade Level & Year of Graduation *
Student's Date of Birth *
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DD
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Student's Current Address *
Parent/Guardian Name(s) (residing with student) *
Parent/Guardian (residing with student) Phone Number *
Parent/Guardian (residing with student) Email *
Last Date of Attendance at NCAHS (occurred or projected) *
MM
/
DD
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YYYY
Reason for Withdrawal *
Student's Plan Upon Leaving NCAHS *
Where should student records be forwarded? (Name of School/Institution & Full Address) *
Contact Person Facilitating Transfer at New School (Full Name & Title) *
Contact Person's Email *
Contact Person's Phone Number *
The parent/guardian signature below (digital) officially approves the student's withdrawal from Norfolk County Agricultural High School.

The parent signature also gives consent for NCAHS to release student records to the school or contact person indicated. School health records obtained from our nurse will travel confidentially.


 *
A copy of your responses will be emailed to the address you provided.
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