BUCKEYE LOCAL SCHOOLS STUDENT WITHDRAWAL FORM
NAME _______________________________________GRADE_____ ID __________________
DATE OF WITHDRAWAL ________________________# CODE FROM BELOW__________
FORMER ADDRESS ____________________________________________________________
NEW ADDRESS _________________________________________________________________
NEW SCHOOL NAME ___________________________________________________________
NEW SCHOOL ADDRESS ________________________________________________________
NEW SCHOOL DISTRICT IRN ____________________________________________________
The undersigned acknowledges the above mentioned student is withdrawing from the Buckeye Local
School District on the above-mentioned date. The undersigned also gives permission to the school to
release records to the school mentioned above.
________________________________________________
Parent or Guardian
Withdraw/Dropout/Truancy Reason
36 Withdrew from Preschool (for any reason)
37 Withdrew from Kindergarten
40 Transferred to another school district out of Ohio
41 Transferred to another Ohio school district–local, exempted village, city or community school.
42 Transferred to a private school
43 Transferred to home schooling
44 No Longer Used
45 Transferred by Court Order/Adjudication (if court has designated a public district other than
yours as district responsible for paying for the education) or if student was placed in an
institution operated by Dept. of Youth Services (DYS)
46 Transferred out of the United States
47 Withdrew pursuant to Yoder vs. Wisconsin
48 Expelled
51 Verified Medical Reasons (doctor’s authorization on file)
52 Death
71 Withdrew due to truancy/nonattendance
72 Pursued employment/work permit (Supt. approval on file)
73 Over 18 years of age
74 Moved; not known to be continuing
75 Completed Course Requirements (Has not passed all of OGT sections)
99 Completed Grad Requirements
