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Student withdrawal form template

Withdraw a student from a school, course or class.

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How to make a student withdrawal form

  1. 1

    Check the questions: rename, add or delete any field, or change how it’s answered.

  2. 2

    Add your organisation’s name, a contact line and your logo if you like.

  3. 3

    Choose fillable PDF, printable PDF, Word or HTML, and the paper size.

  4. 4

    Download the student withdrawal form and share it, print it or add it to your website.

About this student withdrawal form

A withdrawal form ends a student’s enrollment in a school, college course, tuition class or activity. It records the last day, the reason, any refund requested and the items to return, and gives the school a chance to ask what could have been done better.

If the student is moving to another school and needs records sent, use the student transfer form instead.

What’s on the student withdrawal form

The template has 5 sections and 14 questions. Every one can be renamed, moved or deleted.

  • Student: Student name; Class / grade; Student ID or admission no.
  • Withdrawal: Last day of attendance; Reason (choose one: Moving away, Home schooling, Financial, Health, Not satisfied, Other); Details; Refund requested (yes or no); Refund to (account or method)
  • Feedback (optional): Is there anything we could have done differently?
  • Signatures: Student signature with date; Parent or guardian signature with date
  • Office: Clearance (tick all that apply: Fees settled, Books returned, ID card returned); Processed by; Date

Tips

  • Check the refund and notice policy before choosing a last day.
  • Settle fees and return items to get documents released.
  • The feedback question is optional but helps the school.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.

Frequently asked questions

Will I get a refund?

That depends on the school’s refund policy and notice given. The form records the request; the school decides.

Can an adult student sign it?

Yes. Students over 18 sign for themselves; the parent signature is for minors.

Can I get the student withdrawal form as a Word document?

Yes. Choose “Word” under “Save as” to download a .docx file you can keep editing in Microsoft Word, Google Docs or LibreOffice.

Is anything I type sent to a server?

No. The editor runs in your browser and builds the file on your device. Atifo has no server that could receive your form or the answers on it.

Can I put the student withdrawal form on my website?

Yes. Choose “HTML” to copy ready-made form code with labels and a simple style. Set the form’s action to the address that should receive submissions, such as your own form handler.

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