EdPlan Exit Student Form

Please fill out ALL information. (Do not use EdPlan Exit Student Form for Graduates/Certificate of Completion, Ineligible IEPs, Revocation of Parental Consents, or Placement changes within the same district).

Student Last Name

Student First Name

Date of Birth MM/DD/YYYY

Gender Male Female

Current Grade

School Exiting

Exit Reason

Effective Date (Exit Date) MM/DD/YYYY

Moved to (if known)

Additional Comments

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EdPlan Exit Student Form