West Islip Public Schools
The Michael and Christine Freyer Administration Building
100 Sherman Avenue, West Islip, New York 11795
TEL: (631) 893-3200 ⋅ FAX: (631) 893-3212

THIS FORM MUST BE COMPLETED BY THE PARENT OR GUARDIAN OR PERSON IN PARENTAL RELATIONSHIP.

Transferring to Private School

Please fill out a separate line for each enrolled student that you would like to transfer from West Islip Schools to private school. 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: * 🛈

Name of New School or District: *

Last Day of School: * +

Student 2:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Name of New School or District:

Last Day of School: +

Student 3:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Name of New School or District:

Last Day of School: +

Student 4:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Name of New School or District:

Last Day of School: +

Student 5:

Student's Last Name:

Student's First Name:

School Enrolled: 🛈

Name of New School: *

Last Day of School: * +

Print First and Last Name of Person Completing Form: *

Your relationship to the student(s)? *

Please enter your email: 🛈

Please enter your phone number: *