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Withdrawal Form

The Withdrawal Form is used when a student is withdrawing from one LEA and moving to another LEA. (TX69)

Selection Criteria

Selection criteria determine which database records are used in the report. For the Withdrawal Form, student records are selected.
Student Selection

  • Prior to running the report use Student Search to make your current selection the students who need this report.

Report Input

Follow the list of steps to locate and generate the report.

  1. On the Start Page, click State Reports. The Reports page appears.
  2. Click Withdrawal Form. The Withdrawal form report page appears.
  3. Enter information in all of the required fields.
  4. Click Submit to generate the report.



Always use Current Selection

Select the option “The Select x Students Only”

Records Requestor

Select the person who is requesting the withdrawal form.

District Name (if Requestor)

Enter the name of the District requesting the withdrawal form.

School Year

Choose the school year for the student enrollment data to be included in the report. This value populates the school year field within the extract.

Term For grades

Select the marking period of grades to display on the withdrawal form.

Exit Date Override

Enter the withdrawal date if it is different from the Exit date of the student.

Run Now

Select this option if the user wants to run the report immediately.


Select this option if the user wants to run this report on a scheduled basis. Once this option is selected the following choices are:

  • Run Once
    • Start Date and Start Time to run the report.
  • Repeat
    • Select Daily, Weekly, Monthly or Yearly for the appropriate re-occurrence for running the report.
      • If Daily is selected, click the Weekdays only box to limit to weekdays.
      • If Weekly is selected, select which weekday to run the report.
      • If Monthly is selected, select the month to run the report.
      • If Yearly is selected, select either the date or the weekday to run the report.
  • Date Range – Select No End Date or a date that the re-occurrence should end.

Report Output: Withdrawal Form Report [pdf]

Each of the fields displayed in the output of the report are described below. See Understanding the Report Output Table for a definition of each column in the table.

Data Element


District Name

District Name

School Name

School Name

School ID

School ID

School Phone Number

School Phone Number


Name of the student


Generation Code for the student

Date of Birth

Date of Birth



State Student Number

State Student Number

SSN/State Approved Alt ID

SSN/State Approved Alt ID

ID last reported to PEIMS

Noted if a student changed from a state number to SSN

Local Student ID

Student Number

Newest Entry Date

Latest entry date from students

Last Withdrawal Date

Withdrawal date from enrollment or entered from the report options

Placed in grade

Identifies if the student was placed in a grade

Promoted to Grade

Identifies if the stuent was promoted to a grade

Current Grade Level

Current Grade Level


Identifies the scheduling ethnicity


Identifies if the student is Hispanic/Latino


Identifies the federal races for the student

Home Language

Identifies the student’s home language


Identifies if the student is in the bilingual program.


Identifies if the student is in the ESL program.


Identifies if the student is in the gifted and talented program.


Identifies if the student is in the LEP program

Special Education

Identifies if the student is in the special education program.

Title I

Identifies if the student is in the Title I program.

Free/Reduced Lunch

Identifies the student’s economically disadvantaged status.


Identifies if the student is in the Migrant program.

Schooling: Texas School, Home School, Private School, Out of State

Identifies if the student is transferring to another Texas school, home school, private school or out of state school.

Current Grades

Identifies the grades for each class at the time of withdrawal. The grades displayed are based on the report option selected at the time the report is run.

For attendance to be reported once per absence when the section spans multiple periods on the same date the following setup is required:

  • The Section must be coded for Attendance to be taken Once for All Meetings.
  • In System > Quick Lookup Preferences the setting must be checked for Count Multi-Period Meeting attendance once per day.


Signatures of the particular administrators and parents affirming the information on the form.

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