Withdrawal From Section 504 Form
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1
2Date: ________________________
REDMOND SCHOOL DISTRICT
WITHDRAWAL FROM SECTION 504 FORM
Student’s Name:
ID#:
Grade:
School:
Program:
Case Manager:
The above named student was:
Withdrawn
Date Departed from School:
From Redmond School District
Address of new School (if known):
EXIT CODE______________
Prior Notice has been sent to Parent
Withdrawn
From Special Services Section 504
EXIT CODE______________
Current address at time of withdrawal:
EXIT Codes
(Refer to Exit Code Definitions)
1
Graduated
2
Dismissed from 504, returned to General Education
3
Deceased
4
Moved, Continuing Education
5
Dropped Out
6
Eligible for Individualized Education Plan (IEP)
H: ransfer-Withdrawal504-new.doc;kmd9-8-08
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