Oyster River Cooperative School District

Oyster River High School

55 Coe Drive
Durham, New Hampshire 03824

 

Oyster River High School – Student Withdrawal/Transfer Form

 

Name _________________________________________ Age _____________ Date _____________________

 

Birth Date ______________________ Locker No. ___________________ Class ________________________

                                                         Grade                   Books(s)

          Subject                                   to date                  Returned                                     Teacher Signature

 

1. ________________________________________________________________________________________

 

2. ________________________________________________________________________________________

 

3. ________________________________________________________________________________________

 

4. ________________________________________________________________________________________

 

5. ________________________________________________________________________________________

 

6. ________________________________________________________________________________________

 

7. ________________________________________________________________________________________

                                                        

Fees Due: Library ____________ Main Office ____________ Nurse ____________ Cafeteria ___________

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Reason for withdrawal/transfer – Please complete or check one

 

________ School Transferring to: ______________________________________________________________

                                                                (Name & Address)

________ If not transferring to another school, please fill out items below:

 

Lack of interest _______, Disciplinary difficulties _______, Entering military _______, Low grades _______,

Need to work _______, Need to help at home _______, Marriage _______, Medical problems _______,

Other (please specify) _______________________________________________________________________

 

___________________________________________ ______________________________________________

     Student Signature                                                           Parent (Guardian Signature

 

___________________________________________ ______________________________________________

     Counselor Signature                                                      Principal’s Signature

                                                                                                                        Email

Credits earned by Student __________ Contact telephone # __________    Address ______________________

 

Mailing Address ____________________________________________________________________________

 

Long Range Plans ____________________________________________ Official withdrawal date __________