Learner Withdrawal Form

Withdrawal Form & Family Exit Survey

We value the time we have spent with your child and we thank you for the privilege of allowing us to be a part of their education. The sole purpose of this survey is to find ways to better serve the families in our community. Please complete the following survey to the best of your ability and be as candid as possible. All responses are confidential. We thank you in advance, and please let us know if we can assist you in any way in the future.

Parent/Guardian 1
Name

First NameLast Name
Relation to learner(s)

Other
Email
Parent/Guardian 2
Name

First NameLast Name
Relation to learner(s)

Other
Email
Learners
Number of learners whom you wish to withdraw from Dayspring Academy
Learner 1
Learner's Name

First NameLast Name
Gender
School Location
Grade
Effective withdrawal date

MonthDayYear
New school's name
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school
Learner 2
Learner's Name

First NameLast Name
Gender
School Location
Grade
Effective withdrawal date

MonthDayYear
New school's name
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school
Learner 3
Learner's Name

First NameLast Name
Gender
School Location
Grade
Effective withdrawal date

MonthDayYear
New school's name
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school
Learner 4
Learner's Name

First NameLast Name
Gender
School Location
Grade
Effective withdrawal date

MonthDayYear
New school's name
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school
Learner 5
Learner's Name

First NameLast Name
Gender
School Location
Grade
Effective withdrawal date

MonthDayYear
New school's name
New school's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New school's phone number

Area CodePhone Number
Please send transcript to new school
What is the reason for which your family is leaving Dayspring? (please select all that apply)

Other
Comments

Academics

Dayspring Academy is doing an excellent job in teaching

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
Reading
Writing
English / Language Arts
Mathematics
Sciences
Humanities
Foreign Language
Art
Theatre
Music
Dance
Physical Education
Technology
Study Skills / Habits

Resources

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
My child(ren) received a quality education at Dayspring
My child(ren) have access to a variety of learning resources
Dayspring's class sizes contribute to the overall quality of the program
Dayspring's curricular programs are broad enough to meet the educational needs of all learners in the community
Relationships between teachers and parents are strong
I feel the environment at Dayspring is safe for learners
I feel comfortable approaching the front office for assistance
Administrative leadership is effective and organized
Dayspring's facilities are clean and well maintained

Social

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
Learners show respect for one another
Dayspring's discipline policies are fair and effective
Dayspring provides learners and teachers with a safe and orderly environment
Teachers and administrators at Dayspring show genuine concern for the well-being of learners
Discipline problems are competently handled
Dayspring tries to bring out the best in each learner

Communication

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
Parents feel welcome at Dayspring
Communication about Dayspring's programs and operations are regular and informative
Communication platforms are useful and contain the necessary information about operations and programs
Communications were clear on how to contact teachers and administrators
Dayspring addresses parent concerns seriously and quickly

Thank you for providing this information to us. We wish you and your family all the best on your educational journey.
Your comments are important to us:

Withdrawal is only valid when you have received confirmation from Dayspring Academy.

Please do not hesitate in contacting our Student Services department if you have any questions (studentservices@dayspringacademy.org).
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Withdrawal Form & Family Exit Survey

Parent/Guardian 1

Parent/Guardian 2

Learners

Learner 1

Learner 2

Learner 3

Learner 4

Learner 5