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Notification of Student Withdrawal Form

RAPCS_LOGOFINAL

Richard Allen Preparatory Charter School

2601 S 58th Street Philadelphia, PA 19143

Phone: 215-878-1544 | Fax: 215-727-0711

Formal Notification of Student Withdrawal

Date of Student's Withdrawal from Richard Allen Preparatory Charter School*

Answer required for "Date of Student's Withdrawal from Richard Allen Preparatory Charter School"

To (Name of New School): *

If you do not wish to provide the name of your child's new school or your child's next school is undetermined, please write "N/A".

Answer required for "To (Name of New School): "

From: Richard Allen Preparatory Charter School

If you would like to provide further comment on the reason for your child's withdrawal from Richard Allen Preparatory Charter School, you may do so here.

Answer required for "If you would like to provide further comment on the reason for your child's withdrawal from Richard Allen Preparatory Charter School, you may do so here."

Name of Student*

Answer required for "Name of Student"

Student's Date of Birth*

Answer required for "Student's Date of Birth"

Student's Legal Address*

Please include the street, city, state, zip code, and apartment number, if applicable.

Answer required for "Student's Legal Address"

Name of Parent/Guardian*

Answer required for "Name of Parent/Guardian"

Please upload your ID. Examples include driver's license, PennDOT Non-Driver's ID, passport photo, etc.*

Answer required for "Please upload your ID. Examples include driver's license, PennDOT Non-Driver's ID, passport photo, etc."

Choose a file or drag it here.

Please read and confirm the following statement.*

Answer required for "Please read and confirm the following statement."

I certify that as of the above referenced date, my child, as listed above, is no longer enrolled at the Richard Allen Preparatory Charter School.

Signature of Parent/Guardian*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"