Plano Independent School District Attn: Student Records Department 2700 W. 15th Street Plano, TX 75075
INTENT TO WITHDRAW I am withdrawing my child from the Plano Independent School District for the reason listed below. I am the legal guardian of this student. I plan to enroll him/her in the school named below on or about the date indicated. Student Name:
____________________________________________________________
Grade Level:
____________________
Expected Date of Withdrawal from Plano ISD:
Student ID #:
__________________
____________________________________
Name of Plano ISD School: ______________________________________________________ Withdrawal Reason: ____________________________________________________________
Expected Date of Enrollment at Next School:
____________________________________
Name and Address of Next School: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ If withdrawing to attend College in an academic program, indicate whether you will be a full time student enrolled in at least 9 hours: ________Yes _________No If moving, please provide a forwarding address if known: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________
_______________________________________________ Printed Name of Parent or Legal Guardian
________________________ Relationship
_______________________________________________ Signature of Parent or Legal Guardian
________________________ Date
_______________________________________________ Signature of School Administrator/Title
________________________ Date
(PISD school records will be sent upon request from next school.) Student Records Form SR-L02 01-29-2010
Clark High School 523 W. Spring Creek Pkwy. Plano, TX 75023
INTENTO DE RETIRAR Yo estoy retirando mi hijo/a de las escuelas del Distrito de Plano por la razon nombrado abajo. Yo soy el guardian legal de este estudiante. Yo voy a inscriber el/ella en la escuela nombrada abajo en la fecha indicada. Nombre del estudiante: __________________________________________________________ Grado:
____________________
Frecha de retararse de Plano ISD:
#de ID del Estudiante:
__________________
____________________________________
Nombro de su escuela en Plano: ___________________________________________________ Razon de retirarse:
____________________________________________________________
Fecha de inscribirse en su proxima escuela: ____________________________________ Nombre y direccion de la escuela: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Si estan cambiando de damicilio, favor de poner su nueva direccion: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________
_______________________________________________ Nombre de Padre o Guardian Relacion
________________________ al estudiante
_______________________________________________ Firma de Padre o Guardian Fecha
________________________
_______________________________________________ Frima de Administrador de la escuela/Titulo Fecha
________________________
(PISD school records will be sent upon request from next school.) Student Records Form SR-L02 3-20-03