Student Withdrawal Form

Please complete this form to begin the withdrawal process from Academy District 20 (D20).
The student’s current D20 school will follow up if you have any district technology, books, fees, or equipment that need to be returned.
If you have additional questions, please contact your student’s current D20 school.

Student Information

First Name

First Name

Last Name

Last Name

Date of Birth

Date of Birth

Grade Level

Grade Level

Current School

Current School

Parent / Guardian Information

Parent / Guardian Name

Parent / Guardian Name

Email

Email

Phone

Phone

Withdrawal Details

Last Date of Attendance

Last Date of Attendance

New School (If Applicable)

New School (If Applicable)

New Residential Address (If Moving)

New Residential Address (If Moving)

Reason for Withdrawal

Reason for Withdrawal

Additional Comments

Additional Comments

I certify the information provided is accurate and complete. By submitting this form, I acknowledge this constitutes my electronic signature.

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