Student Withdrawal Form

If you are withdrawing a student from the Kent City School District, this is the form that you need to complete.

*PLEASE NOTE THAT ANY SCHOOL MATERIALS NEED TO BE RETURNED to the student's school including Chromebooks, library books, and textbooks.

If you are withdrawing multiple students, you will need to fill out a Withdrawal form for each of them.

Student Name Student Name First Last
Student's Date of Birth Student's Date of Birth / MM / DD YYYY
Current Grade

Current Grade Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Please choose your student's current grade.

After the last day of school, please choose the grade that your student is going into for the upcoming school year.
Last Date of Attendance Last Date of Attendance / MM / DD YYYY

What is the last date that your student will attend school here in Kent?
Withdrawing from:

Withdrawing from: Davey ES, 196 N Prospect St., 330-676-7400 Holden ES, 132 W School St., 330-676-8400 Longcoy ES, 1069 Elno Ave., 330-676-8350 Walls ES, 900 Doramor St., 330-676-8300 Stanton MS, 1175 Hudson Rd., 330-676-8600 Roosevelt HS, 1400 N Mantua St., 330-676-8700

Which school are you withdrawing your student from?
New School DISTRICT Name

What is the name of your student's new school district?
New School Name

What is the name of your student's new SCHOOL?
New School Address New School Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
What is the name of your student's new school?
New School PHONE Number New School PHONE Number - ### - ### ####

What is the phone number of your student's new school?
New School FAX Number New School FAX Number - ### - ### ####

What is the FAX number of your student's new school?
New Home Address New Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
If you are NOT moving, please put your CURRENT home address.
Your relationship to the student
Your email address
I affirm that all of the information above is correct. I understand that withdrawn students must be enrolled in a new school within two weeks of the Kent City School District withdrawal date, or they will be considered truant per Ohio Revised Code 3321.13.

Printed Name I affirm that all of the information above is correct. I understand that withdrawn students must be enrolled in a new school within two weeks of the Kent City School District withdrawal date, or they will be considered truant per Ohio Revised Code 3321.13.

Printed Name First Last
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.