Student Withdrawal Form

Student Withdrawal Form

ACG School Jakarta
Student/s name and Year Level*
Student name*

First nameLast name
Student ID Number*
Homeroom/Advisor*
Details of Parent/Guardian
Your name*

First NameLast Name
Email address*
example@example.com
Withdrawal details
Planned last day of school*

DayMonthYear
Reason for withdrawal
Moving to another school in Jakarta

Australian Intercultural SchoolBritish School JakartaBinus SchoolGlobal Jaya SchoolJakarta Intercultural SchoolNew Zealand SchoolSampoerna AcademyOther
Destination country
Name of school
Notes*
Additional information such as next destination (school/country)
As part of the withdrawal process, we may schedule an Exit Interview with the Principal or Vice-Principal Primary.

We will be in contact with you to arrange the appointment.

Regards,

ACG School Jakarta
Should be Empty:

Details of Parent/Guardian