SHMS Student Withdrawal Form

To initiate the student withdrawal process, please complete the following form. Information collected will be used for records and statistical analysis in our efforts to ensure a positive, safe and successful experience for all students. Should there be additional questions regarding your withdrawal, you may be contacted by a school administrator. Thank you for your time and honesty.

Please select the student's current grade level.​
Please provide the name(s) of the student's parent(s) or guardian(s).​​
Enter the approximate date of when the school was first notified of your plans to not return to SHMS. (If the completion of this form is your first notification, you may use today's date.)​​
Please provide the name of the new school the student will be attending. If new school is outside of the Louisville area, please provide the city and state. ​
Please indicate which answer(s) below best describes the reason(s) the student/family is leaving Sacred Heart Model School. Check all that apply.​​​
If you selected "other" on the previous question, please explain.​​
Are there any other details you would care to share regarding the withdrawal of the student?​

By submitting this form, I understand that no school records will be released from Sacred Heart Model School until tuition and related fees have been paid in full to the SHS Business Office.
(Please contact Shawna Haley at 896-3911 ext. 1501, for final tuition & related fees amount.)

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