GCSEC Student Drop Form

Student Name
Serving School
Resident District
Program/Service Dismissed from
Teacher/Therapist Name
Reason for Exit:
Example: Moved, Not Eligible, Not Eligible, Other (please explain)
Exit Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year(last day attended or serviced)
Notes
This should be completed for each student that drops or is dismissed from your program/class to ensure accurate state reporting. If you have questions please let Phoebe know. Thanks!
Should be Empty: