SPS Student Withdrawal Form

Stratford Public Schools!

Withdrawal/ Transfer Form
To officially withdraw your child from Stratford Public Schools, please complete and electronically sign the provided online form. The school will then contact you with further instructions.
Today's Date

MonthDayYear
Date
I, Parent First & Last Name, *wish to officially withdraw my child from * as of Last Day of Attendance.*
The reason for withdrawing/transferring is (check one):*

Moving to another Public School DistrictHomeschoolingEntering a Private SchoolEntering Continuing Education ProgramOther
Name of School District *
Private School Name*
Private School Address*

Street Address

Street Address Line 2

CityState

Zip Code
Name of New School*

School NameAddress (Street, City State and ZIP)
STRATFORD/TRUMBULL CONTINUING EDUCATION PROGRAM

Students discontinueing public schooling at the age of 17, must enroll in and accredited Countuing Educatoin Program -parent/guardian signature below attest to student will enroll in an adult education program upoon withdrawal from school.

Link to enroll in adult education program: https://studentportal.literacypro.com/ct/providers/254
AUTHORIZATION TO RELEASE STUDENT RECORDS: (if applicable) ** All Chromebooks and chargers, library books, textbooks and property of Stratford Public Schools must be returned before records will be released**

I have withdrawn/transferred the above student from Stratford Public Schools and authorize the release of academic/scholastic records; medical/health records and Confidential Records - Special Education information, psychoeducational evaluations, PPT minutes and/or any other specialized information.
Student*

First NameLast Name
Grade*
Date of Birth*

MonthDayYear
Date
Parent/Guardian's Name*

First NameLast Name
Home Address (Provide new address if moving):*

Street Address

Street Address Line 2

CityState

Zip Code
Parent Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Request Approval From:
Admin Signature*

Clear
Admin Date Signed

MonthDayYear
Date
Approvers Email
example@example.com
School Personnel Email
example@example.com
Should be Empty:

Stratford Public Schools!