shelby county schools 9th

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SHELBY COUNTY SCHOOLS
9TH-12TH WITHDRAWAL FORM
LAST DATE OF ATTENDANCE:__________________
DATE:_____________________
RELEASE DATE:_________________
STUDENT’S NAME:______________________________________________________________________
SSN:____________________GENDER:___________DOB:_________________CURRENT GRADE:_______________________
SCHOOL INFORMATION
FROM:
TO:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
TELEPHONE:(_______)______________________
FAX:(______)_____________________________
GRADES FOR _____________REPORTING PERIOD:
SUBJECT
HOMEROOM
1
2
3
4
5
6
7
SCHOLASTIC
TEXTBOOKS TEACHER'S
GRADE
CONDUCT RETURNED SIGNATURE
THIS STUDENT RECEIVES SPECIAL ED SERVICES: Y
BOOKS CLEAR: Y N
___________________
N
SPEECH
LIBRARY CLEAR: Y N
504
_______________________
THE STUDENT IS CURRENTLY UNDER A SUSPENSION/EXPLUSION: Y N ___________________________
(c) (1) Every parent, guardian or other legal custodian residing within this state having control or charge of any child or children between six (6) years of age
and seventeen (17) years of age, both inclusive, shall cause the child or children to attend public or nonpublic school, and in event of failure to do so, shall be
subject to the penalties provided in this part. The LEA in which a transfer student seeks to enroll may require disclosure and copies of the student's records
in accordance with the Family Education Rights and Privacy Act, compiled in 20 U.S.C. § 1232g et seq., including, but not limited to, disciplinary records from
educational agencies where the student was previously enrolled.
I HAVE READ THE ABOVE TN COMPULSORY ATTENDANCE LAW.
PARENT’S SIGNATURE______________________________________________________DATE:__________________________
PRINCIPAL’S SIGNATURE___________________________________________________________________
Shelby County Schools offers educational and employment opportunities without regard to race, color, national origin, religion, sex, or disability.
VISIT SCS ON THE INTERNET @ WWW.SCSK12.ORG
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