Withdrawal Link Send Reflection Form

Please submit this form every time you send the withdrawal link to someone UNLESS the student is moving or graduating. It will be dropped into Jess’s label so she can help you brainstorm whether anything should have been done differently or can still be done!

Submitted By *
Submitted By
Student Name *
Student Name
Name of Student's Teacher *
Name of Student's Teacher
Did you have this withdrawal discussion with an adult student or a student's parent? *
Check all formats in which your withdrawal discussion with this student/parent took place *
If any part of your conversation took place via email or text, please drop the email in my label or email me the text conversation *
Did you share your conversation with the teacher and/or TC? *