WITHDRAWAL FROM WOODSIDE HIGH SCHOOL
CLEARANCE FORM
199 Churchill Avenue
Woodside, CA 94062-2306
(650) 367-9750, Ext. 4318
Fax (650) 306-8854

Name of Student _____________________________________________________
This clearance is very important to you. Your record must be clear if you wish to transfer to another school and have your records and future transcripts forwarded. The School District may now withhold transcripts and your records for failure to clear all fines and fees. This position is consistent with California State law.

Date of Withdrawal:________________Reason for leaving________________________________________________

Transferring to School____________________City__________________State_____
Consent of parent (written or verbal) must be given to the Vice-Principal before a clearance slip may be issued, except in the case of graduates.

Written – phone – In person Signed________________________________________

Secure Vice Principal's Signature ________________________________________

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DIRECTIONS FOR WITHDRAWING FROM WOODSIDE HIGH SCHOOL

Sign out with all your teachers during regular periods. Please consider that it may take more than one day to secure signatures (A/B schedule). The teacher must indicate the grade to date of leaving which is the total time the student has been in your class during the semester, not just for the time since the last grading period. Please avoid sending in “incomplete” and “no grades” since it will be impossible for the student to makeup such grades in another school.

Period	Classes	Teacher Signature	Check-out Grade
1
2
3
4
5
6
7

1.Secure Library Clearance__________________________________________________

2.Textbook Clearance______________________________________________________

3.Immunizations O.K? = Secure Health Aid Signature____________________________

4.Secure Gym Locker Clearance_____________________________________________

5.Secure Attendance Office Clearance_________________________________________

6.Secure Signature of Guidance Secretary______________________________________

STOP! HAVE YOU CONTACTED THE SCHOOL YOU WILL BE ATTENDING?

Does the receiving school have similar courses?

Have you thought about mid-term exams, final exams and transfer grades?

Does their school calendar coincide with Woodside's calendar?

Will you lose credit by transferring now?

What documents do you need?

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CHECK LIST FOR COMPLETING THE “ WITHDRAWAL FROM WHS ” FORM

_______Obtained a signature from each teacher and department listed on the form.

_______When obtaining teacher signatures and grades in progress, take into

consideration the A/B schedule.

_______Returned all textbooks to the library and pay any library fines that are due.

_______Returned the completed withdrawal form to the guidance office and pick up the

following:

• A copy of your grades in progress.

• An unofficial copy of your transcript
  .
• A copy of your immunization records to give to your new school.

These documents will make it much easier for you to enroll in your new school.

_____________________________	_______________________________
Student Signature	Parent Signature