Interior Distance Education of Alaska

Withdrawal Request

* Fields Are Required
Your name:	(if different from parent)
Date (mm/dd/yy):*
Parent/Guardian Name:*
Family Key:	(if Known)
Region:*
City:
Phone:*
IDEA Email Address:*
Alt. Email Address:*
Student Name(s)*
Portion Of Family:*
Reason For Withdrawal:*
Effective Withdrawal Date:*	(If left blank it will use today's date)
School Transferring To:
Additional Notes:
Please click the submit button below; you will be contacted by an IDEA representative to go over your withdrawal.