School Release Form printable pdf download

School Release Form

Students applying for MU High School’s Diploma Program, who are under the

age of 18 and reside in the United States, must complete either section A or B.

Student name: ________________________________________________________________________

Student Date of Birth: __________________________________________________________________

A. Previous School Acknowledgement

School Name: _________________________________________________________________________

Address: _____________________________________________________________________________

____________________________________________________________________________________

The above student is withdrawing from stated school and is applying to the University of Missouri High

School Diploma Program.

Signature of principal or counselor: ________________________________________________________

Date: ______________________________________________________

Printed name of principal or counselor: _____________________________________________________

Principal or counselor’s phone number: (_____) __________ ‐ ________________ ext: _____________

-OR-

B. Home School Compliance Statement

We certify that our family is in compliance with our state’s home school laws

Parent signature: ______________________________________________________________________

Date: _____________________________________________________

∙

306 Clark Hall Columbia, MO 65211

Phone: 573‐884‐3974

Fax: 573‐884‐9665

∙

Web: mizzouk12online.missouri.edu

Email: mizzouk12online@missouri.edu

School Release Form