School Release Form - University of Missouri

School Release Form

Students applying for MU High School's Diploma Program, who are under the age of 18 and reside in the United States, must complete either section A or B.

Student name: ________________________________________________________________________ Student Date of Birth: __________________________________________________________________ A. Previous School Acknowledgement School Name: _________________________________________________________________________ Address: _____________________________________________________________________________ ____________________________________________________________________________________ The above student is withdrawing from stated school and is applying to the University of Missouri High School diploma program. Signature of principal or counselor: ________________________________________________________

Date: ______________________________________________________ Printed name of principal or counselor: _____________________________________________________ Principal or counselor's Phone number: (_____) __________ - ________________ ext: _____________

-OR-

B. Home School Compliance Statement We certify that our family is in compliance with our state's home school laws Parent signature: ______________________________________________________________________ Date: _____________________________________________________

306 Clark Hall Columbia, MO 65211 Phone: 573-884-3974 Fax: 573-884-9665 Web: mizzouk12online.missouri.edu Email: mizzouk12online@missouri.edu

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