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Pupil Withdrawal Form


Upon a student’s withdrawal from a school, the LEA must document the withdrawal of students and maintain the Official Notice of Pupil Withdrawal on file along with supporting documentation in accordance with the LEAs record retention policy. This is to ensure that the schools comply with the Official Notice of Pupil Withdrawal policies and procedures. This form is a single-page PDF containing the demographic, school enrollment, and program data of the student. The form is expected to be verified and signed by parents and school staff to ensure that the information is correct.

Selection Criteria

This report has no specified selection criteria.

Report Input


Choose one of the following:

  • Current School Only – Includes all student records associated with the current school that meets selection criteria. To change the current school, click the School link at the top of the page and choose the appropriate school from the list.
  • All Schools – Includes all student records on the PowerSchool server that meet selection criteria.

Note: The All Schools option is only available when running the report from the District Office.

Students to Include

Select one of the following:

  • The Selected [number] Students Only – Run the report for students in the current selection.
  • All Students (default) – Run the report for all students in the current school or district that meet the selection criteria.

Note: If running the report for a single student, or group of students, select the students before running a report.

Start Date 

Enter the report start date.

End Date  Enter the report end date.
District/Charter IDEnter the unique district identification number.
SchoolEnter the school identification number.

Report Output

Data ElementDescription[Table]FieldName

Legal Name (Last, First Middle Suffix)

Student's Legal Name

Format: Last Name, First Name, Middle Name, Suffix





Grade Level Code

The student’s grade level entered on the Transfer Info > Edit Enrollment page.


  • PS = PK4, PK3, PK2
  • KG = KG
  • UE = Grade KG with the Ungraded Elementary field box checked.








Choose either female or male.

Valid values:

  • F – Female
  • M – Male



Enter the student’s social security number.


Student Number

Enter the locally assigned student number.


Date of BirthStudent's date of birth.[Students]DOB
Primary Withdrawal Type (Exit Code)

Select the following that best describes why the student is withdrawing from school:

Exit Codes

  • WD Demoted to the previous grade level during the current school year
  • WK Transferred to another calendar track within the same school
  • WP Promoted to the next grade level during the current school year
  • W1/S1 Transferred to another school in-state. S99 Student transferred to another school within this district during summer
  • W21/S21 Transferred to attend school out of state
  • W22/S22 Transferredtoattendschoolinanothercountry
  • W2 Withdrawal due to chronic illness
  • W3 Expelled or long-term suspension
  • W4/S4 Attendance record showing 10 consecutive days of unexcused absence or status unknown
  • W5/S5 Dropout -no intention of completing necessary requirements for a diploma
  • W6/S6 Age out (Older than 22 years of age or younger than 6 years of age)
  • W7/S7 Met all high school graduation requirements and awarded a diploma
  • W15 Met all requirements for Grand Canyon Diploma and awarded diploma
  • W8/S8 Deceased
  • W9/S9 Transfer to be home taught
  • W10/S10 Transferred to state detention or correctional facility W11/S11 Withdrawal to obtain GED
  • W12/S12 Transfer to vocational or technical school which does not award HS diploma
  • W13/S13 Completion of a course of study at CTED before or after graduation
  • W17 Received GCD; no longer enrolled full-time in AZ public university
  • W18 Received GCD; no longer enrolled full-time in AZ community college
  • W14 Met all requirements but not awarded GCD; continuing in high school
  • W19/S19 Eligible for GCD; the student is no longer enrolled in a full-time CTE program W20 Awarded GCD; post GCD participation unknown or ineligible


[Students] exitcodeWK

[Students] exitcodeWP   























Additional Withdrawal Reason


Select one of the following only if applicable:

  • WR1 School identified for Federal School Improvement
  • WR2 School identified as persistently dangerous
  • WR3 Individual Transfer Option (victim of a violent criminal offense)
  • WR4 Pregnancy/Biological Parent of a Child





Summer Withdrawal DateThe last day of attendance or summer withdrawal date of the student.[Students]SummerWithdrawalDate

Select all disability categories for which the student has been identified as eligible.

A Autism

OHI Other Health Impairment

DD Developmental Delay

OI Orthopedic Impairment

ED Emotional Disability

PSD Preschool Severe Delay

EDP Emotional Disability Separate Facility, Private

SID Severe Intellectual Disability

HI Hearing Impairment

SLD Specific Learning Disability

MD Multiple Disabilities

SLI Speech/Language Impairment

MDSSI Multiple Disabilities Severe Sensory Impaired

TBI Traumatic Brain Injury

MIID Mild Intellectual Disability

VI Visual Impairment

MOID Moderate Intellectual Disability

[S_AZ_STU_SPED_Service_C ]ServiceCode
ELL Services

State if the student is undergoing ELL services




Reason for withdrawing from ELL Services

 Reason for exiting the ELL services:

  • Parent Withdrawn ELL
  • No Parent Withdrawn ELL





Parent Withdrawn ELL

NoParentWithdrawnELL ,

District/CharterThe District/Charter entity ID.



School IDThe state assigned public or charter school entity identifier[Schools]AZ_EntityID

Signature of the person submitting the form.

DateThe date on which the form was submitted,logDateAddedBY

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