Withdrawal Form

indicates a required answer

Withdrawal Form

1. *	Name of Student Withdrawing

2. *	Date of Withdrawal

3. *	Name of Parent

4. *

Will the parent also be withdrawing service hours?

Yes, please pull all of my service hours.

No, I still have other children in the co-op.

5. *

How would you like to pay?

Each student is a $75 withdrawal fee.

Pay by Zelle [email protected]		Have Dawn charge the card you have on file.
Have Dawn add this charge to your CHEAR account balance.