Withdrawal Notice

EPIC RESOURCES

Please complete the following form to officially withdraw from Epic Charter School.

Name of Person Completing Form * First Last
Email of Person Completing Form *

Parent and Student Information

Parent or Guardian Name * First Last

Phone *

Email *

Student Name * First Last

Sex *

MaleFemale

Grade Level *

Is the student moving to a new address? *

YesNo

New Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Withdrawal Information

Reason for Withdrawal *

If other, please elaborate. *

Name of Country *

Last Day of Enrollment at Epic Charter School *

Name and Address of New School

New School Name *

New School Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Special Education Services

Important If the student being withdrawn is receiving Special Education services, please note the following and mark accordingly.

This student has

an active IEP and is receiving Special Education services.a 504 Plan.

Forwarding Records Student educational records will be forwarded to the receiving school upon written request.
Additional Comments
Electronic Signature *
By electronically signing this document, I am attesting that all of the information I have provided is accurate and correct to the best of my knowledge and is intended to serve as my official signature. The Electronic Signatures in Global National Commerce Act, 15 U.S.C. § 7001, redefines a traditional signature as: (a) In General, Notwithstanding any statute, regulation, or other rule of law (other than this subchapter and subchapter II of this chapter), with respect to any transaction in or affecting interstate or foreign commerce-(1) a signature, contract, or other record relating to such transaction may not be denied legal effect, validity, or enforceability solely because electronic signature or electronic record was used in its formation.I verify that the information provided above is accurate

Verification

Please enter any two digits *Example: 12
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EPIC CHARTER SCHOOL

100 South Anaheim Blvd., Ste. 150
Anaheim, CA 92805
PH: 657.220.1000
FAX: 657.220.1105

HOURS:

M-F 9 a.m. to 5 p.m.

EMAIL:

info@epiccalifornia.org

FOLLOW US:

CHILD FIND

Child Find is a search for all children with disabilities who are not receiving a free, appropriate, public education. This applies to children between the ages of birth and twenty-one years of age, who have not yet graduated from high school. EPIC Charter School oﬀers full educational opportunities for all students. If you suspect your child may have a disability, or know of a child with a disability who is not receiving a free, appropriate, public education, please click here.

OUR AUTHORIZER

EPIC Charter School is a California public TK-12th grade school authorized by the Orange County Board of Education.
Click here to access school board meeting information.

EPIC RESOURCES