Request to Un-Enroll Student

	Please fill out this form if your student will be leaving (un-enrolling) their current school. This request will be forwarded to school staff for processing.

1.	Student Name*

2.	Student's Current School*
	--Please Select--Camarillo Heights STEM AcacemyDos Caminos ElementaryLa Mariposa ElementaryLas Colinas Middle SchoolLas Posas ElementaryLos Primeros School of Sciences & ArtsMonte Vista Middle SchoolPleasant Valley School of Engineering & ArtsRancho Rosal ElementarySanta Rosa Technology Magnet SchoolTierra Linda ElementaryPreschool Early Education Program (PEEP)

3.	What is the reason the student is leaving?*
	Moving out of area/district to somewhere within California.    Moving out of area/district to a different state.    Moving out of area/district to somewhere outside of the United States.    Homeschooling    Private School    Attending a public school outside of Pleasant Valley School District.

4.	Please further explain your reason for leaving.*

5.	If attending another school, what is the name of the school and the city/state where the school is located?* If unknown, enter N/A
	School Name   City   State

6.	Dates of Attendance
	Last Day Attending Current School (XX/XX/XXXX)   First Day Attending New School (XX/XX/XXXX)

7.	Parent/Guardian Contact Information*
	Parent/Guardian Name   Email Address   Phone (XXX) XXX-XXXX

8.	Any other information you would like the school to know about this request?