Student Withdrawal Form - Classical Christian Academy printable pdf download

Withdrawal Form

Request to withdraw from the Connections Program only (no on-campus classes taken)

This form is being initiated by__________________________________________________

Relationship to student___________________

Student’s Name____________________________________ Student’s grade_________

Date change is requested:________________ Date form was initiated:_______________

Effective Date: ________________

1. I have met/discussed with the Administration concerning the reason for my withdrawal.

Administration’s signature___________________________________ Date___________________

2. If requesting a change to your financial agreement, please attach a letter for the Board of Directors clearly

outlining your request.

3. Please note that a withdrawal occurring in the middle of a quarter could result in a WP (withdrawal passing)

or WF (withdrawal failing) on report card and transcripts.

4. Depending on the circumstances, an additional Administration fee of up to $200 may be assessed.

As outlined in the financial agreement, the full amount of the agreement is due unless the Board of Directors

agrees to change your agreement.

Reason for withdrawal: (use extra paper if necessary)

_____________________________________________________________________________________________

Parent’s Signature________________________________________ Date__________________

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Please submit this completed form, along with any additional requests or documentation to

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For business office: _____ OK to release records. ____Do NOT release records until account is current.

Sign:_________________________________________________ Date:__________________________

C:\Users\Amy Davis\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\LHYO5S6V\Withdrawal

Form-Connections only.docx