Date Received: _____________________________ Received by: __________________________________

OFFICIAL WITHDRAWAL REQUEST FORM

This is the Official Withdrawal Request Form that must be completed for students to withdraw. The process can
be delayed if the student has outstanding fees and/or unreturned school equipment. Unreturned school
OFFICIAL WITHDRAWAL REQUEST FORM
properties will automatically be added to the student’s account.
This is the Official Withdrawal Request Form that must be completed for students to withdraw. The process can
be delayed if the student has outstanding fees and/or unreturned school equipment. Unreturned school
Note:
properties will automatically be added to the student’s account.
AUTHORIZED GUARDIAN/S must present an Authorization Letter signed by the parent and valid ID.
Note:
Only PARENTS/AUTHORIZED GUARDIAN are allowed to withdraw the student.
The PARENTS/AUTHORIZED GUARDIAN must provide the updated home address and contact AUTHORIZED GUARDIAN/S must present an Authorization Letter signed by the parent and valid ID.
number.
Only PARENTS/AUTHORIZED GUARDIAN are allowed to withdraw the student.
 The PARENTS/AUTHORIZED GUARDIAN must provide the information about the school where
The PARENTS/AUTHORIZED GUARDIAN must provide the updated home address and contact
the student will be transferred.
number.
 This Form must be accompanied by the Student Clearance Form.
 The PARENTS/AUTHORIZED GUARDIAN must provide the information about the school where
the student will be transferred.
Requested Date of Withdrawal: _________________Grade Level:  This Form must be accompanied by the Student Clearance Form.
Student’s Complete Name: ______________
Student’s Date of Birth: ___________________ Requested Date of Withdrawal: _________________Grade Level:
Student’s Complete Name: ______________

Reason for Withdrawal: ¨ We will be moving to another location in the Philippines. Student’s Date of Birth: ___________________

¨ We will be moving out of the country / We will return to our home country
¨ Our child will be attending at a private / public school. Reason for Withdrawal: ¨ We will be moving to another location in the Philippines.
¨ We will be moving out of the country / We will return to our home country
¨ Other:
¨ Our child will be attending at a private / public school.
Name of School ¨ Other:
Address of New School Name of School

Student’s Updated Address Address of New School

Home Phone No.: Cell No.: Student’s Updated Address

Home Phone No.: Cell No.:

________________________ ________________________

Signature over Printed Name Date ________________________ ________________________

Signature over Printed Name Date
AS THE STUDENT CLEARANCE FORM IS SUBMITTED, THIS IS TO BE FILLED OUT BY NOBLESSE ADMIN:

AS THE STUDENT CLEARANCE FORM IS SUBMITTED, THIS IS TO BE FILLED OUT BY NOBLESSE ADMIN:
Date Received: _____________________________ Received by: __________________________________