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Student Permanent Withdrawal

About this Form

Form number: 565-4

Audience:  School Staff

Last revised: July 2017

Related Forms

Form 565-4a - Educational Interview for Withdrawal Prevention

Introduction: COMAR 13A.08.01.07E provides that each local school system shall develop and implement a procedure to conduct an educational interview with any student (age 18 and over*) who leaves school prior to graduation, or with the parent/guardian of such student or with all the above. The purpose of the interview is to encourage the student to remain in the student’s current school program or enroll in an alternative school program. The interview should verify the reason, or reasons, for the student dropping out of school and ensure that the parent/guardian is informed. See MCPS Regulation JEC-RA, Student Withdrawals from Classes and School.
This form should be completed by the school counselor, pupil personnel worker (PPW) or a school administrator, after completing MCPS Form 565-4a, Educational Interview for Withdrawal Prevention. A resource packet providing opportunities outside or in addition to the traditional K–12 educational system, should be made available to the student at the time of the interview. If the student is not present for the interview, this form should be completed and attempts should be made to mail the resource packet.

*Annotated Code of Maryland, Education Article Section 7-301 (a) 1.  

Adobe PDF Student Permanent Withdrawal178 KEnglish
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