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THIS FORM MUST BE COMPLETED BY THE PARENT/GUARDIAN OR PERSON IN PARENTAL RELATIONSHIP.
Intent to Unenroll
Please fill out a separate line for each enrolled student that you would like to unenroll from the South Huntington Union Free School District. If you require more space, please submit a second form.
Today's Date
*
Student 1:
Student's Last Name:
*
Student's First Name:
*
School Enrolled:
*
🛈
Birchwood
Countrywood
Maplewood
Oakwood
Silas Wood
Stimson
Walt Whitman
Out of District Placement
Name of New School or District:
*
Last Day of School:
*
+
Student 2:
Student's Last Name:
Student's First Name:
School Enrolled:
🛈
Birchwood
Countrywood
Maplewood
Oakwood
Silas Wood
Stimson
Walt Whitman
Out of District Placement
Name of New School or District:
Last Day of School:
+
Student 3:
Student's Last Name:
Student's First Name:
School Enrolled:
🛈
Birchwood
Countrywood
Maplewood
Oakwood
Silas Wood
Stimson
Walt Whitman
Out of District Placement
Name of New School or District:
Last Day of School:
+
Student 4:
Student's Last Name:
Student's First Name:
School Enrolled:
🛈
Birchwood
Countrywood
Maplewood
Oakwood
Silas Wood
Stimson
Walt Whitman
Out of District Placement
Name of New School or District:
Last Day of School:
+
Student 5:
Student's Last Name:
Student's First Name:
School Enrolled:
🛈
Birchwood
Countrywood
Maplewood
Stimson
Oakwood
Silas Wood
Walt Whitman
Out of District Placement
Last Day of School:
+
Print First and Last Name of Person Completing Form:
*
Your relationship to the student(s)?
*
Do you have a new address:
*
Yes
No
New address:
*
The answer you give below will help the district determine what services you or your child may be able to receive under the McKinney-Vento Act. Students living in temporary housing situtions may be McKinney-Vento eligible and entitled to services.
Where will the student reside?
*
In permanent housing (House, Apartment or Other)
In a shelter
With another family or person because of loss of housing or as a result of economic hardship (sometimes referred to as "doubled-up")
In a hotel/motel
In a car, park, bus, train, or campsite
Other temporary living situation
Other temporary living situation
Reason for leaving last residence:
*
Sale of property
Eviction
Foreclosure
Fire (Natural Disaster)
Neutrally agreed termination of contract
Relocating
Mold/Infestation/Substandard Conditions
Not leaving residence
New Residence:
*
Formal Contract
Verbal Agreement
Renting the entire property
Renting an apartment within the property
Renting a bedroom
Please enter your email:
🛈
Please enter your phone number:
*
My signature below certifies that I have been informed and understand my rights under the McKinney-Vento Act.
Signature:
*
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