Student Withdrawal Form

Student Withdrawal Form

ACG School Jakarta
Student name *

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

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

Day Month Year
Reason for withdrawal
Moving to another school in Jakarta

Australian Intercultural School British School Jakarta Binus School Global Jaya School Jakarta Intercultural School New Zealand School Sampoerna Academy
Destination country
Name of school
Notes
If you have any additional information regarding the withdrawal plan, please write here
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