*All answers kept confidential
(Note: If you are not in good standing, your courses will be cancelled for upcoming semesters; and you will need to do a readmission application to reregister for courses)
The date that you submit this form or the date of notification, whichever is later, will be considered your last date of attendance for financial aid and student accounts purposes. Your financial aid may be adjusted if you withdraw before 60% of the semester is completed. Students accounts will adjust tuition, fees, room and board charges based on a pro-rated basis. (Please see the Office of the Controller.)
Copies of this form are forwarded to the student's advisor, the Dean of Students, the Chief Student Affairs Judicial Officer, Student Accounts, the Director of Financial Aid and the Director of Retention and Advisement.