Pupil Withdrawal Form

Introduction

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

Field	Description
Use	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 ID	Enter the unique district identification number.
School	Enter the school identification number.

Report Output

Data Element	Description	[Table]FieldName
Legal Name (Last, First Middle Suffix)	Student's Legal Name Format: Last Name, First Name, Middle Name, Suffix	[StudentCoreFields]PSCore_Legal_Last_Name [StudentCoreFields]PSCore_Legal_First_Name [StudentCoreFields]PSCore_Legal_Middle_Name [StudentCoreFields]PSCore_Legal_Suffix
Grade Level Code	The student’s grade level entered on the Transfer Info > Edit Enrollment page. Note: PS = PK4, PK3, PK2 KG = KG UE = Grade KG with the Ungraded Elementary field box checked.	[Students]Grade_Level [Reenrollments]Grade_Level [S_AZ_STU_CONENR_C]Grade_Level [Students]UngradedElementary [Reenrollments]UngradedElementary [S_AZ_STU_CONENR_C]UngradedElementary
Gender	Choose either female or male. Valid values: F – Female M – Male	[Students]Gender
SSN	Enter the student’s social security number.	[Students]SSN
Student Number	Enter the locally assigned student number.	[Students]StudentNumber
Date of Birth	Student'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]exitcodeWD [Students] exitcodeWK [Students] exitcodeWP [Students]exitcodeWS1 [Students]exitcodeS99 [Students]exitcodeWS21 [Students]exitcodeWS22 [Students]exitcodeW2 [Students]exitcodeW3 [Students]exitcodeWS4 [Students]exitcodeWS5 [Students]exitcodeWS6 [Students]exitcodeWS7 [Students]exitcodeW15 [Students]exitcodeWS8 [Students]exitcodeWS9 [Students]exitcodeWS10 [Students]exitcodeWS11 [Students]exitcodeWS12 [Students]exitcodeWS13 [Students]exitcodeW17 [Students]exitcodeW18 [Students]exitcodeW14 [Students]exitcodeWS19 [Students]exitcodeW20
Additional Withdrawal Reason (Optional)	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	[Students]WithdrawalReaWR1 [Students]WithdrawalReaWR2 [Students]WithdrawalReaWR3 [Students]WithdrawalReaWR4
Summer Withdrawal Date	The last day of attendance or summer withdrawal date of the student.	[Students]SummerWithdrawalDate
SPED	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 Yes/No	[S_AZ_STU_ELL]Services [VirtualTablesData]Custom
Reason for withdrawing from ELL Services	Reason for exiting the ELL services: Parent Withdrawn ELL No Parent Withdrawn ELL	[AZ_StudentNeed]AZ_ELL_ExitReasonCode [VirtualTablesData]Custom Parent Withdrawn ELL NoParentWithdrawnELL ,
District/Charter	The District/Charter entity ID. ,	AZ_LEA_ENTITY_ID
School ID	The state assigned public or charter school entity identifier	[Schools]AZ_EntityID
Signature	Signature of the person submitting the form.	logPersonAddedBY
Date	The date on which the form was submitted,	logDateAddedBY