Withdrawal Form - Canal Winchester Schools

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CANAL WINCHESTER HIGH SCHOOL
WITHDRAWAL FORM
300 Washington Street
Canal Winchester, Ohio 43110
Date______________
614-833-2157
Student’s Name
_____________________________________________________
Address
_____________________________________________________
Current Grade
______ Date of Birth ________________ Phone_____________
New Address /Phone_____________________________________________________
Receiving School
_____________________________________________________
School Address
_____________________________________________________
I verify that my child is withdrawing as of the above date and that his/her transcript and
any other relevant information may be released to the receiving school district when this
form has been properly completed, submitted to the High School Office, and all fines
have been paid.
Parent/Guardian Signature ________________________________________________
Check Out (Teachers please fill out information below)
Current
Returned Fine or
Teacher
Teacher/Class
Grade
Books_ Cost/Book
Signature
1.
______________________
________
Yes
No __________
_________
2.
______________________
________
Yes
No __________
_________
3.
______________________
________
Yes
No __________
_________
4.
______________________
________
Yes
No __________
_________
5.
______________________
________
Yes
No __________
_________
6.
______________________
________
Yes
No __________
_________
7.
______________________
________
Yes
No __________
_________
8.
______________________
_________
Yes
No __________
_________
Outstanding Fees
date withdrawn
withdrawal code

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