Standard Withdrawal Form for Students Entering K-12 Scholarship Programs
A school district or charter school shall, at the request of a student’s parent or guardian, complete this form if the student was enrolled in the district or charter school in the prior school year or is enrolled in the current school year. The parent or guardian shall submit the completed form to the scholarship funding organization prior to scholarship funding.
Parent Request for Withdrawal
|
||||||
| Student Information | ||||||
| First Name | Middle Name | |||||
| Last Name | ||||||
| FLEID # | Date of Birth | |||||
| Parent/Guardian Information | ||||||
| First Name | Phone Number | |||||
| Last Name | Email Address | |||||
| By submitting this form to the school district or charter school administrator, I am requesting that this withdrawal form be completed by ___________________ School/School District. | ||||||
|
|
||||||
Parent/Guardian Signature
|
Date
|
|||||
Public School District or Charter School Responsibility
|
||||||
| Withdrawal Information | ||||||
| Name of the Public School | ||||||
| County/District name | ||||||
| Date of Withdrawal from above named Public School | ||||||
| Withdrawal Code _____________________
| ||||||
| I certify that the above withdrawal information is accurate. | ||||||
|
|
||||||
School District or Charter School Administrator Signature
|
Date
|
|||||
School District or Charter School Administrator Name
|
School District or Charter School Administrator Title
|
|||||
Rule 6A-6.0952, F.A.C.
Form IEPC-SWF
Effective July 2025