Withdrawal Form

This form is used to withdrawal from all classes within a current term and/or from the university.
Student ID #*
Are you withdrawing from more than one term?*
- Yes
- No
Select Terms*
- Spring
- Summer
- Fall
Select Term*
Term's Year*
Withdrawing from the program and all classes for the appropriate term checked. The OFFICIAL date of withdrawal is determined by the date that the first contact is made by the student to initiate the withdrawal process. Charges and/or refunds to the student's account and grades are based on this date.
Select Program*
Receiving TA/VA Benefits (Military)*
- Yes
- No
Name*
First Last
Last Date of Attendance*
**Participation is defined as engaged in an academically related activity
Address*
Street Address City State / Province / Region ZIP / Postal Code
Contact Number*
Email*
Enter Email Confirm Email
Reasons for Withdrawal*
Signature*
I agree that the above information is accurate, and that I am the student whose name appears on this form
CAPTCHA

Form has been tagged under:Registrar

Introduction