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Student Withdrawal Form

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Cheerful Heart Academy

Student Withdrawal Form


1. *

Withdrawal Date:

2. *

Student's Name:

3. *

Student's Date of Birth:

4. *

Student's Grade Level:

5. *

Parent's Name:

6. *

Parent's email address:

7. *

Reason for withdrawal - if going to a new school, please provide name and address if you have it:


How many days has this student attended school since being enrolled this year? (If you answer this question, you will not be required to fill out the attendance form unless you want to.)

Student educational records will be forwarded to the receiving school upon written request. I will accept requests via the form on the Cheerful Heart Academy website, email, mail, or fax. Please remember that the only records kept by Cheerful Heart Academy are attendance and whatever records the parent has decided to send in. 

I will need your final attendance records to be sent in when you withdraw your student. You can click on the attendance button to submit attendance or give the final tally of days above. 

If you have any questions, contact Lynda at [email protected]