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Boiling Springs High School

Withdrawal and Clearance Form

Student's Name:   Grade:

Date of Withdrawal: Date of Birth:  Age:

Address:

Reason for Withdrawal:

Subject

Grades to Date

Teacher

Books Collected

Teacher's Signature
         
         
         
         

Please report to the following areas and obtain clearance.  Records will not be released until all obligations are cleared including books turned in and deficiencies paid.
Library: Parking Permit:
Lock: Student ID:
Guidance: Attendance:
Business Office:  
If this student is a senior, he/she must meet with principal before withdrawing. Principal's Signature:

 

I give permission for the student listed above to withdraw from Boiling Springs High School.  If this is a transfer,

I give permission for Boiling Springs High School to release records to the gaining school upon their request.

Signature of Parent/Guardian:_____________________________________________________

Signature of Student:____________________________________________________________

Signature of Counselor, Assistant Principal, or Principal__________________________________