Get Az Ade-41-123 2019-2026

The AZ ADE-41-123 form is an essential document for schools in Arizona to formally withdraw students. This guide provides clear, step-by-step instructions to help users fill out this form accurately and efficiently online.

Follow the steps to complete the AZ ADE-41-123 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the student's legal last name as it appears on their registration documents in Box 1.
3. Fill in the student's legal first name in Box 2 as it appears on their registration documents.
4. Input the student's middle name in Box 3, if applicable.
5. In Box 4, indicate any name extension (e.g., Jr., Sr., II, III) the student may have.
6. Provide the State Student ID in Box 5, which is a number issued by the Arizona Department of Education.
7. In Box 6, enter the School Student ID, which is a unique number provided by the district or charter.
8. Specify the student's grade level in Box 7, using standard designations such as PS, KG, 1-12, or UE (Ungraded Elementary).
9. Select the student's gender in Box 8 from the options provided.
10. Input the student’s date of birth in Box 9 using the format mm/dd/yyyy.
11. In Box 10a, select the primary withdrawal type that best describes the reason for the withdrawal.
12. Optionally, provide any additional withdrawal reasons in Box 10b if applicable.
13. Complete Box 11 with initials in 11a for the individual updating the Student Management System and the removal date in 11b.
14. In Box 11c, specify the last day of attendance or the summer withdrawal date.
15. Secure the parent's or guardian's signature in Box 12, or the student's signature if they are emancipated.
16. Enter the date the form was signed in Box 14.
17. Fill out the school name in Box 15 and the district/charter number in Box 16.
18. Provide the school number in Box 17.
19. In Box 18, enter the withdrawal code based on the selection from Box 10a.
20. Obtain the signature of a school official in Box 19 and the date signed in Box 20.
21. If applicable, check the relevant Special Education (SPED) categories in Box 21.
22. Complete the ELL information in Box 22, including assessment date and program type if applicable.
23. Once all fields are completed, save changes, and prepare the form for download, printing, or sharing as needed.

Complete the AZ ADE-41-123 form online today to ensure timely processing of pupil withdrawals.