BPS RegistrarStudent Withdrawal Form

BPS Registrar

Student Withdrawal Form

Student State ID Number*

Student Full Legal Name (Birth Certificate)*

School Site*

Select

Date of Withdrawal*

What school is the student transferring to?*

Why is the student leaving BPS?*

Does the student receive Special Ed services?*

Yes

No

Is the student an EL student?*

Yes

No

Is the student Native American?*

Yes

No

Tribal Affiliation*

Select

Does parent authorize release of information (PAF)*

Yes - Parent authorizes to release student information to Tribal Education Departments.

No - Parent does not authorize to release student information to Tribal Education Departments

Email of person submitting withdrawal

Select

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