Special Education Exit Form
District*:
Alanson
Beaver Island
Boyne City
Boyne Falls
Central Lake
Char-Em ISD
Charlevoix
Concord - Boyne
Concord - Petoskey
East Jordan
Ellsworth
Harbor Springs
Northwest Academy
Pellston
Petoskey
Student Last Name*:
Student First Name*:
Exit Date*:
01
02
03
04
05
06
07
08
09
10
11
12
-
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-
2007
2008
2009
2010
2011
2012
2013
2014
2015
Exit Reason*:
01 Graduated from general education with a high school diploma
02 Graduated from general ed. with a high school diploma and applied to degree-granting university
03 Graduated from an alternative program with high school diploma
04 Graduated from general ed. with a high school dimploma and applied to non-degree granting institution
05 Completed general ed. with an equivalency certificate (GED) Must obtain documentation
06 Completed general ed. with other certificate
07 Dropped out of school
08 Enrolled in another public school district in Michigan
09 Moved out of state
10 Expelled from school district with no further services
11 Enlisted in military or Job Corps
12 Deceased
13 Incarcerated
14 Enrolled in home school (instruction provided at home)
15 Enrolled in non-public (parochial or private school)
16 Unknown
17 Placed in a recovery or rehabilitative program
18 Left adult education
19 Expected to continue in same school district
20 Received special ed. certificate of completion and exited the K-12 system
21 Special ed. – reached maximum age and exited the K-12 system
30 Exited early childhood or Early On program/service
Exit Requested By*:
New District of Enrollment, if Known*:
Alanson
Beaver Island
Boyne City
Boyne Falls
Central Lake
Char-Em ISD
Charlevoix
Concord - Boyne
Concord - Petoskey
East Jordan
Ebenezer Christian
Ellsworth
Harbor Springs
Northwest Academy
Pellston
Petoskey
St. Francis
St. Mary
Unknown
Not Applicable
Outside of Char-Em ISD
Send Email Confirmation To
(Please Enter an Email Address)*:
Comments:
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Copyright Charlevoix - Emmet Intermediate School District 2008
Last revised: February 4, 2010