Student Withdrawal Notice

Please use this form if you are choosing to withdraw your student from Northstar School.

Student Name*
Current grade of student*
The above student will be:*
This withdrawal is effective beginning:*
Reason for withdrawal*
Father's Name
First Last
Mother's Name
First Last
Name of the person completing this form:*
First Last
Email of the person completing this form:*
By signing here, I authorize the above withdrawal:*
Your Name
Your Name
Your Name