Editing previous response:

Please fix the highlighted areas below before submitting.

DVA Withdrawal Form

Letter Head

WITHDRAWAL FORM

To the principal of Dove Virtual Academy. The following student has withdrawn from Dove Virtual Academy.

Student First Name*

Answer Required

Student Last Name*

Answer Required

Student Grade Level*

Answer Required

Student Date of Birth*

Answer Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Does student have any school electronic devices or textbooks?*

Answer Required

Yes

Parent / Guardian First Name*

Answer Required

Parent / Guardian Last Name*

Answer Required

Parent / Guardian Email*

Answer Required

Parent / Guardian Phone*

Answer Required

Reason for Withdrawal*

Answer Required

New School Name*

Answer Required

New School Website*

Answer Required

New School Contact Info*

Answer Required

Parent Signature: Please print parent/guardian's full name e-signature*

Answer Required

Withdrawal Date*

Answer Required

Confirmation Email

Confirmation Email *

Email Required