Office of the Registrar
The University of North Carolina at Pembroke
Undergraduate Application for Withdrawal
Retroactive
Print completed form and return to the Office of the Registrar.
Mr./Ms./Mrs.________________________________ Banner ID ____________
Classification: Freshman [] Sophomore [] Junior [] Senior [] Special Student []
Mailing Address: ________________________________________________________________
Indicate the term for which you wish to be withdrawn and why specifically do you wish to withdraw from the University?
Term to Withdraw ___________
[] A. Class Schedule [] E. Student/Professor Conflict [] I. Health
[] B. Family Considerations [] F. Friends at another college [] J. Child Care
[] C. Work/School Conflict [] G. Grades [] K. Homesick
[] D. Financial [] H. Not prepared for college [] L. Transportation
[] Other
ON THE REVERSE SIDE, MAKE A WRITTEN STATEMENT OF YOUR REASONS FOR MAKING THIS REQUEST.
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. Student accounts will adjust tuition, fees, and room and board charges based on a pro-rated basis. (Please see the Office of the Controller at the following link: http://www.uncp.edu/co/ )
Student Signature: _____________________________________ Date: _____________________
____________________ __________ ____________________ __________
Advisor Date Cashier Date
____________________ __________ ____________________ __________
Director of Housing & Date Accounts Receivable Date
Residential Life
____________________ __________ ____________________ __________
Director of Financial Aid Date University Registrar Date
____________________ __________
Director of Student Conduct Date
****************************************************
For Office Use Only:
Official Withdrawal Date________________________ ID Card Received_____________________
Meal Plan Invalidated __________________________ Receipt No._________ Date ____________
REQUEST TO RECEIVE A GRADE OF “W” BASED ON UNUSUAL CIRCUMSTANCES
Approved [] ____________________________________________________________________
Denied [] Associate Vice Chancellor for Academic Affairs Date
cc: [] Accounts Receivable [] Financial Aid Office [] Student Affairs [] Student [] Advisor
Up to the last day to receive a W in a course, a student may complete a "Request for Withdrawal" form, available from the Office of the Registrar. The student should get the required signatures, take the I. D. card to the Student Accounts Office, and return the form to the Office of the Registrar. The University makes applicable refunds only after the withdrawal procedure is completed.
After the last day to receive a W in a course, the Office for Academic Affairs approves withdrawal from the University without academic penalty only when unusual and documented circumstances warrant. Unsatisfactory academic performance does not by itself meet the requirement. As soon as possible, and no later than before the beginning of the last two weeks of classes in the semester, the student petitioning to withdraw from the University must meet with the Associate Vice-Chancellor for Academic Affairs, present the required documentation, and complete the necessary forms. Approved request receive W in all courses. Students who stop attending classes without completing the withdrawal procedure ordinarily receive an F in courses for which they are registered.
DIRECTIONS TO THE STUDENT:
The University of North Carolina at Pembroke
Office of the Registrar
PO Box 1510
Pembroke, NC 28372-1510
If Student Never Attended Any Classes:
Professors Will Need To E-mail Shirley.floyd@uncp.edu