Student Withdrawal and Exit Survey

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This school is accredited by the Oklahoma State Department of Education.* This field is required.Educations records, including a complete transcript with be sent upon request
Piedmont Early Childhood Center, 11020 W. Memorial Rd, Yukon, OK 73099, 405-373-5190
Northwood Elementary School, 14100 Northwood Dr, Piedmont, OK 73078, 405-373-5151
Piedmont Elementary School, 1011 Piedmont Road N, Piedmont, OK 73078, 405-373-2354
Stone Ridge Elementary, 10000 W Memorial Rd, Yukon, OK 73099, 405-373-4227
Piedmont Intermediate School, 977 Washington Ave, Piedmont, OK 73078, 405-373-5155
Middle School of Piedmont, 823 2nd St NW, Piedmont, OK 73078, 405-373-1315
Piedmont High School, 1055 Edmond Rd NW, Piedmont, OK 73078, 405-373-5011
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Student's Legal Name* This field is required.
First Name
Last Name
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Student's Date of Birth* This field is required.
Date
Month
Day
Year
4
Last Grade Successfully Completed* This field is required.
PK
K
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2
3
4
5
6
7
8
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10
11
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Current Enrollment Grade* This field is required.
PK
K
1
2
3
4
5
6
7
8
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10
11
12
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Last Date Attended* This field is required.This is the last day your student was/will be in class.
Date
Month
Day
Year
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School Site Attended* This field is required.
Piedmont Early Childhood Center
Northwood Elementary
Piedmont Elementary
Stone Ridge Elementary
Piedmont Intermediate
Middle School of Piedmont
Piedmont High School
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Parent/Legal Guardian Name* This field is required.
First Name
Last Name
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Reason for Withdrawal* This field is required.
Moved to another school district in Oklahoma
Moved to another state
Moved to a private school in Oklahoma that is not affiliated with any religion
Moved to a private school in another state that is not affiliated with any religion
Moved to a private, religious school in Oklahoma
Moved to a private, religious school in another state
Moved to a school outside of the country
Transferred to an institution
Transferred to home school (parent taught)
Transferred to a charter school (Epic, K12, OCVA, etc)
Discontinued schooling
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New School/Institution Information* This field is required.
Name of student's new school or institution
Address of new school or institution
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Date student is scheduled to start at new school* This field is required.
Date
Month
Day
Year
12
Private School Information
Name of Private School
Address of Private School
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Date Student is scheduled to start at private school* This field is required.
Date
Month
Day
Year
14
Please provide any supplementary information concerning your student's withdrawal from Piedmont Public Schools* This field is required.
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Which of these factored into your decision to go to this school? (select all that apply)* This field is required.
Specialized focus of curriculum/content area
Parental involvement opportunities
Private school performance results
Innovative teaching approach
Diversity or Inclusion
Religious studies
Private school voucher
Other.....
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Please provide any supplementary information concerning your or your student's withdrawal from Piedmont Public Schools* This field is required.
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Withdrawal to Home School * This field is required.This letter is to acknowledge that you, as the legal parent/ guardian, wish to withdraw the above-named student from Piedmont Public Schools for the purpose of educating him/her at home. By completing this form, you acknowledge your responsibility to provide an equivalent education to the one he/she would receive in an accredited school. The following recommendations are made from the Oklahoma State Department of Education for home instruction: 1. Maintain the homeschool for 180 days per school year. (70 O.S. 1-109) 2. Conduct the homeschool six clock hours or 360 minutes per day. (70 O.S. 11-111) 3. Follow a definite curriculum or design for learning. (70 O.S. 11-103) 4. Establish a method to determine and document that academic progress has occurred. (Oklahoma Administrative Code 210:35-3-368) In addition, by completing this form, you understand that in the event your student re-enroll in public school, a standardized test will be administered for appropriate placement. You further understand that your student has a right to a public education. However, by making your choice for homeschooling, you release the Piedmont School District from the responsibility for educating the above-named student. The Piedmont Public School district is not obligated to provide textbooks, materials, resources, or any other aid to your child while you have chosen to homeschool. I have read and understand my responsibility to provide an appropriate education for my child. By typing your name in the designated fields below, you are electronically signing this document, which is considered a legally binding digital signature equivalent to a handwritten signature.
Parent/Legal Guardian First Name
Parent/Legal Guardian Last Name
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Today's Date* This field is required.
Date
Month
Day
Year
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Charter School* This field is required.
Name of student's new school
Address of student's new school
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Date student was/will be enrolled at Charter School* This field is required.
Date
Month
Day
Year
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Which of these factored into your decision to go to a Charter school? (select all that apply)* This field is required.
Specialized focus of curriculum/content area
Parental involvement opportunities
Charter school performance results
Innovative teaching approach
Diversity or Inclusion
Other
22
Please provide any supplementary information concerning your student's withdrawal from Piedmont Public Schools* This field is required.
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If you or your student has chosen to discontinue schooling, what are the student's future plans?* This field is required.
Pursue a GED
Join the workforce
Attend a trade school
Other
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