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Undergraduate Colleges
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___________________________________ ___________________ Print
Last Name, First, MI
Student ID# Student: ________/_________/_________ CMS BOX: _______________ School / Class / Curriculum (STREET AND NUMBER) (CITY)
(STATE) (ZIP) INDICATE PARTICIPATION: CHECK BELOW ¯EOF ¯FINANCIAL AID ¯HOUSING ¯VA BENEFITS TO
THE REGISTRAR: I WISH TO WITHDRAW FROM _______________________________________ (COLLEGE)
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FOR THE FOLLOWING REASON(S): CHECK BELOW (TERM/YEAR) ¯PERSONAL ¯FINANCIAL ¯HEALTH ¯OTHER EXPLAIN BRIEFLY: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Have
you registered for next semester? (circle) YES
NO If so, do you intend to return? (circle) YES NO X STUDENT’S SIGNATURE DATE |
REGISTRAR’S OFFICE USE ONLY DATE RECEIVED ¯W ¯C ________________________ EFFECTIVE DATE (The effective date will be the date of the first approved Dean’s signature below. This form is invalid unless presented to the Registrar within 72 hours of the first Dean’s signature) Cancel: From__________To_________ _____________________________ REGISTRAR AUTHORIZATION/DATE ADMINISTRATIVE APPROVAL ONLY APPROVAL
SIGNATURES/DATES: ________________________________ OFFICE
FOR STUDENT AFFAIRS DATE ________________________________ FINANCIAL AID DATE |
Students must complete Student’s Section on the front
side in its entirety before this form will be processed.
The form must then be signed as follows:
A. Office for Student Affairs, Second Floor, Armitage Hall
B. Financial Aid Office, Lower Level, Armitage Hall
1. If your withdrawal is prior to the beginning of the term and you cancel your entire registration for one or more credit hours:
RESULT: No grades will be recorded and you will be entitled to a 100% refund of tuition and fees paid for the term. Registration material for the next term will not automatically follow. If you wish to re-enroll at a later date, secure an Application for Re-enrollment available at the Student Affairs Office.
2. If your withdrawal is effective on or after the first day of the term, but before the last day of the sixth week and you withdraw from all coursework:
RESULT: Grades of “W” will be assigned and tuition charges will be reduced according to the following schedule:
Week of Term: First/Second Third/Fourth Fifth/Sixth
80% 60% 40%
College Fees are not refundable.
3. If your effective withdrawal date is during the seventh through twelfth week of the term:
RESULT: There is no refund of tuition and fees. Grades of “W” will be assigned. Registration materials will be
automatically sent to you for the term following your withdrawal.
The effective date of withdrawal is that date on which a written statement of withdrawal is received by the Registrar’s Office. No part of the student fee is refunded for withdrawals after the start of the term. Non attendance in class has no bearing on the refund policy. Actual meeting dates of individual courses have no bearing on the refund policy.
The Summer Session has slightly different rules and regulations regarding withdrawal and refunds. See the current Summer Catalog for exact details.
Rev. TR 12/98
Do not write below this line.
BURSAR’S OFFICE USE ONLY
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