RSS INTERNATIONAL EDUCATION
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Student Withdrawal
International Student Withdrawal
When you are leaving RSS, please complete the following form and give to your ELL/International Teacher.
Student Name: _____________________________
Date: _____________________________
Step 1: Library – Textbook / Library book Return
All books returned? YES / NO - If NO (attach statement) $ ____________.
Bookroom/Library Signature:____________________________________
Step 2: Office
HomeRoom Teacher _______________ Locker # _____________ Combo:___________
Returned YES / NO
Fees Paid? YES / NO - If NO (attach statement) $ ____________
Office Signature for all school fees paid: _____________________________________________
Step 3: Meeting with ELL/International Teacher
Meeting Date:_____________
ELL/International Signature:______________________________
Notes: