Student Withdrawal Form

Student Withdrawal Form

ACG School Jakarta
Student/s name and Year Level
For multiple students, kindly put name, 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
2 digit day, 2 digit month, 4 digit year
Reason for withdrawal
Moving to another school in Jakarta

Other
Destination country
Name of school
Notes
Additional information such as next destination (school/country)
Parent Consent

Must be completed by both parents
Name

First NameLast Name
Relationship with the student
Signature
Name

First NameLast Name
Relationship with the student
Signature
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