San Juan Unified School District School Withdrawal Form

San Juan Unified School District School Withdrawal Form

To withdraw your student from a San Juan Unified School District school, please complete this form. Please use one form per student. Please include a copy of your VALID ID. Only Legal Parents/Guardians can withdraw students. Requests can take up to five business days to process. You will receive an email upon completion.
Legal Parent/Guardian Name

First NameLast Name
Legal Parent/Guardian Email
example@example.com
Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Name (full legal name)

First NameLast Name
Student's 6-Digit Student ID Number
If unknown, use 000000
Student Date of Birth

MonthDayYear
Date
Student's Current Grade
Did your student have a 504 plan?
Did your student have an IEP (Individualized Education Plan)?
Are you moving outside of the San Juan Unified School District boundaries?
Release of Responsibility:

Please be advised that by withdrawing your student from the district, San Juan Unified School District is released from all responsibilities regarding your child's Individualized Education Program (IEP). This includes, but is not limited to:
- All IEP-related services (such as speech therapy, occupational therapy, specialized instruction, etc.)
- All current and future Offers of a Free Appropriate Public Education (FAPE)
- District-funded assessments and accommodations
Please Note: Should your student re-enroll in a public school within our district boundaries in the future, the IEP process and evaluation of services can be re-initiated at that time
What is the last date of attendance in the San Juan Unified School District? (the date you want your student withdrawn)

MonthDayYear
Date
What is your student's current school?
What is the school your student was to attend next year?
Name of Student's New School
Address of the New School

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have shared custody?
Reason for Withdrawal
Upload a picture of a valid parent ID.

Cancelof
Should be Empty: