Student Withdrawal Form

Student Withdrawal Form

Please allow up to 72 business hours for processing.
Student Name*

First NameLast Name
Student ID #*
Campus*
Grade Level*
Student Date of Birth:*

MonthDayYear
Date
Person Submitting Request:*
Name of Person Submitting Request:*

First NameLast Name
Email of Person Submitting Request:*
example@example.com
Phone Number of Person Submitting Request:*
Please enter a valid phone number.
Current Address of Person Submitting Request:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will the Student be Moving to a New Address?*

YesNo
New address (if applicable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Government Issued Photo Identification of Person Submitting Request*

Cancelof
Reason Student is Withdrawing:*

Student Will Be Homeschooled - I understand that effective immediately, my child will be homeschooled in a bona fide manner using a written curriculum consisting of written materials and other teaching tools that will meet and exceed the educational goals of all course subjects.Transferring to Another Texas Public School (ISD)Transferring to a Charter SchoolTransferring to a Private SchoolTransferring to a School Outside of TexasTransferring to an Accredited Private School (including Job Corp)Returning to Home CountryThe student does not plan to enroll in any schoolCPS removalOther
If you have selected "Other", please provide details below:
Name of New School District Where the Student Will Be Enrolling:*
Name of New School Where the Student Will Be Enrolling:*
Student's Last Day of Attendance*

MonthDayYear
Date
Start Date at New School *

MonthDayYear
Date
Student Email (if applicable)
example@example.com
Does the student have any technology devices or other property belonging to Duncanville Independent School District?*

YesNo
If yes, please deliver the student devices, including case and charger to the IDEA Hub at 900 South Cedar Ridge Road, Duncanville, TX. 75137
Presenting a false record or falsifying records is a criminal offense punishable by up to 10 years and $10,000. TEXAS PENAL CODE §37.10. A person who enrolls a child under false documents may be liable for the cost of tuition or other costs. TEXAS EDUCATION CODE §25.002(d). I have read and understood the information provided above. I understand that if any of the responses given on this form are found to be false, I will be subject to criminal, civil and administrative penalties. I declare under penalty of perjury under the laws of this state that the information provided here is true and correct and of my own personal knowledge.
Signature*

Clear
Date Submitted*

MonthDayYear
Date
Duncanville ISD - Student Withdrawal Survey

We value your thoughts and impressions as the parent of a Duncanville ISD student who has chosen to withdraw. Please complete the survey below:
The decision to withdraw was made by:*

Parent/GuardianStudentBoth
This survey was completed by:*

MotherFatherGuardian
Reasons for Withdrawal (Check all that apply)*

My family is relocating to another areaDuncanville did not offer the academic programs I wantedDuncanville did not offer the athletic or fine arts programs I wantedDuncanville did not offer the clubs and organizations I wantedStaff customer service was not acceptable (communication, response time, etc.)Student behavior was an issueDistrict facilities were not acceptable (heat and air, cleanliness)Other
Explain exactly why you are leaving and what Duncanville can do to ensure all students received a high-quality education.
Thank you for your participation.

Your feedback is important to us as we review our procedures and plans for the future.
FOR OFFICE USE ONLY

Has a School Behavioral Threat Assessment (SBTA) ever been conducted on this student? (Please review SkyWard for this information)

______________Yes ______________No

If a student has undergone an SBTA, please transfer all related documents to their next school. (Contact Student Services or the review the Skyward Entry/Withdrawal Notes)

Campus Administrator's Signature______________________

Date_________________
Should be Empty:

Student Withdrawal Form

If yes, please deliver the student devices, including case and charger to the IDEA Hub at 900 South Cedar Ridge Road, Duncanville, TX. 75137

Duncanville ISD - Student Withdrawal Survey

Thank you for your participation.