Learner Withdrawal Form If you are human, leave this field blank.Learner Withdrawal FormSchool *iLEAD Hybrid ExplorationLast Day *Last day of school with iLEADJune 5, 2024 (Last Day of 2023-2024 School Year)Learner InformationLearner First Name *Learner Last Name *Grade *TKK1st2nd3rd4th5th6th7th8th9th10th11th12thDate of Birth *Learner Address *Learner City *Learner State *Learner Zip *Special Education *This learner does not receive Special Education services.This learner has an active IEP and is receiving Special Education services.This student has a 504 plan. EF InformationEducational Facilitator First Name *Educational Facilitator Last Name *Educational Facilitator Email *A copy of this form will be sent to your EF upon submission. Parent InformationParent/Guardian Phone *Parent/Guardian Email * General InformationTransferring to *A California Public SchoolA Private SchoolAnother iLEAD SchoolOut of StateOut of the United StatesHome School / Private School Affidavit (PSA)GraduationOtherReason for WithdrawalPlease share any feedback on iLEAD Exploration below.Note If you are withdrawing and filing a Private School Affidavit (PSA) to homeschool, please submit a copy of your PSA to enrollment@ileadexploration.org. New School *Enter new school name and address here.This withdrawal form is not a record request. Student educational records are not forwarded to the new school until a formal written or faxed request from the new school is received by the iLEAD’s enrollment department. The formal record request can be faxed to 657-231-8223, emailed to enrollment@ileadexploration.org or mailed to: iLEAD Exploration Attn: Registrar 2973 Harbor Blvd #616 Costa Mesa, CA 92626 Parent/Guardian Name *Type full name in box reCAPTCHA is required.Submit {{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. Please contact the developer of this form processor to improve this message. Learn More{{/message}}Submitting…