Request For Withdrawal Form Elementary And Middle School printable pdf download

Request For Withdrawal Form Elementary And Middle School

NORTH CHICAGO COMMUNITY UNIT SCHOOL DISTRICT #187

Office of District Registrar

1717 Seventeenth Street North Chicago, Illinois 60064

Phone: 847-578-7400 Ext. 7249 Fax: 847-689-7478

REQUEST FOR WITHDRAWAL FORM

The Illinois School Code (105 ILCS 5/26-1 et seq.) states that children between the ages of 7 and

17 must attend public school; however, an exception is made for “…..any child attending a

private or parochial school where children are taught the branches of education taught to

children of corresponding age and grade in the public schools, and where the instruction of

the child in the branches of education is in the English language.”

Student’s Name (print): _____________________________________________________

Date of Birth: ______/ ______/ _______ Grade Level: ___________________________

(Indicate the reason for withdrawal below):

MOVING - New Address: __________________________________________________

New School Name: _________________________________________________________

New School City, State, Zip: ______________________, __________ _______________

OTHER REASON (please state):_____________________________________________

New School Name: _________________________________________________________

New School City, State, Zip: ______________________, __________ _______________

DATE OF WITHDRAWAL: _______/ _______/ ________

Parent/Guardian Name (print): ________________________________________________

Signature: ______________________________ Today’s Date: ______/ ______/ _______

Phone Number: ( ________ ) _________-__________

*UPON SUBMITTING THIS REQUEST, YOUR STUDENT IS NO LONGER A STUDENT

WITHIN NORTH CHICAGO SCHOOL DISTRICT. ALL CLASSES WILL BE DROPPED AND

YOU WILL BE REQUIRED TO RE-ENROLL TO ATTEND. THIS INCLUDES PAYMENT OF

FEES, PROOF OF RESIDENCY, AND COMPLETING ALL NECESSARY ENROLLMENT

FORMS.

Office Use Only

Date Received: _________________________________ Date Transferred: _________________________ By: ___________

Request For Withdrawal Form Elementary And Middle School