If you are human, leave this field blank.Learner Withdrawal FormLast day at iLEAD *Last day of school with iLEADLearner InfoLearner First Name *Learner Last Name *Date of Birth *Grade *TKK1st2nd3rd4th5th6th7th8th9th10th11th12thProgram *In which program are you enrolled?Site-based 5 days a weekExploration StudioLearner Street Address *City *State *Zip * General InformationProperty *Do you have any school property/technology to return?YesNoFacilitator/Advisor NameSpecial Education *This learner does not receive Special Education services.This learner has an active IEP and is receiving Special Education services.This student has a 504 plan.Reason for Withdrawal *Transfer to Another iLEAD SchoolTransfer to a Private SchoolTransfer to Another California SchoolTransfer Out of StateTransfer Out of the United StatesTransferring to My Neighborhood SchoolExpand Reason *Please expand on your reason for leaving SCVi.New School *What school should we be expecting a records request from?This form is not a records request – student educational records are not automatically forwarded to the new school. A written request is required before student educational records can be forwarded. Parent/Guardian InformationParent/Guardian Phone *Parent/Guardian Email *Best MethodWhat are the best ways to reach you should any questions arise after your child leaves?SuggestionWhat, if anything, could we have done to help your child stay at the school? Parent/Guardian Signature *Type full name in boxreCAPTCHA is required.Submit
