Withdrawal Form
Name
First Name
Last Name
Student ID
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Status
Graduate
Undergraduate
What is the reason for your withdrawal?
Have you already talked to your class adviser?
Yes
No
Are you planning to return to the school in the future?
Yes
No
Would you like to discuss your relationship to other students, teachers, or staff?
Yes
No
Reminders
All of the student's information can be found in the portal.
Withdrawing during the first week in school will be eligible for refund.
If the student withdraws after the first week, fees will not be refunded.
You need to contact a financial aid prior to withdrawing from the school.
Signature
Date Signed
 -
Month
 -
Day
Year
Date
Registrar's Office Use Only
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Withdrawn By
Withdrawal Date
 -
Month
 -
Day
Year
Date
Submit
Should be Empty: