Student Withdrawal Form - First Presbyterian Academy, Inc

1. Parent Full Name *

2. Student Full Name *

3. Current Grade Level *

4. Reason for Withdrawal - Please check all that apply * (1 required)

Academic Difficulty Change of Residence Discipline Problem Financial Situation Illness Parental Dissatisfaction Student Dissatisfaction FPA Requested Withdrawal Parent Requested Withdrawal

5. If your reason for withdrawing is financial, have you contacted the Business Office * (1 required)

Yes No

6. If your reason for withdrawing is academic, have you contacted the appropriate division principal? * (1 required)

Yes No

7. What factor(s) contributed to your decision to withdraw from First Presbyterian Academy? *

8. How satisfied were you with the quality of education your child received while attending FPA? * (1 required)

Very Satisfied Satisfied Dissatisfied Very Dissatisfied

9. What did you like best about FPA? *

10. What area(s) did you have concerns about with FPA? *

11. Have you shared your concerns with anyone at FPA prior to deciding to withdraw? * (1 required)

Yes No

12. If yes, who?

13. How do you compare this year to previous school years at FPA? * (1 required)

Better About the Same Worse

14. If you selected Worse, in what way(s)?

15. What type of school will your student be attending? * (1 required)

Public Charter Private - Independent Private - Religious Homeschool Other

16. What is the name the new school your student will attend? *

17. What qualities are you looking for in a new school? *

18. Is there anything else you would like to share with us? *

19. If change of residence, please include your new home address and phone number:

20. How can we pray for your family during this transition?

21. Enter Your Email Address: *