OFFICE OF THE REGISTRAR
THE UNIVERSITY OF NORTH CAROLINA AT PEMBROKE
UNDERGRADUATE APPLICATION FOR WITHDRAWAL
(AFTER THE FIRST SIX WEEKS OF CLASS)
Directions: Please print, complete and return to the Office of the Registrar.
Mr./Ms./Mrs.________________________________ Student Identification Number ____/____/____
Classification: Freshman [] Sophomore [] Junior [] Senior [] Special Student []
Mailing Address: ________________________________________________________________
Why specifically do you wish to withdraw from the University?
[] 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.
Student Signature: _____________________________________ Date: _____________________
Department Last Date Progress/Current Verified by signature
Course-Section Professor Attended Grade in Course or phone call/Date
____________________ __________ ____________________ __________
ADVISOR DATE CASHIER DATE
____________________ __________ ____________________ __________
DEAN OF STUDENTS DATE ACCOUNTS RECEIVABLE DATE
____________________ __________ ____________________ __________
DIRECTOR OF DATE REGISTRAR DATE
FINANCIAL AID
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
[] Academic Affairs [] Music Department Chair (if withdrawing from Music Course)
REV. 06/98
A
student who wishes to withdraw from the University before the last date to
withdraw from a class must complete a “Withdrawal from the University” form,
which is available in the Registrar’s Office. The form must be endorsed by the
proper authorities on the form and submitted to the Registrar’s Office.
Applicable refunds will not be made until the withdrawal process is complete.
Only under very unusual circumstances may a student officially withdraw from the University after the last date to withdraw from a class. The student must meet with the Associate Vice Chancellor for Academic Affairs who, after consultation with the faculty, will establish the validity of the request. This process must be initiated before exam week.
Unsatisfactory academic progress by itself is not sufficient basis for being allowed to withdraw officially. If a student’s request to withdraw from the University is denied by the Office of Academic
Affairs, individual grades for the student will be at the discretion of the instructors. Any student who stops attending classes without completing the withdrawal procedure will receive a grade of “F” in all courses for which the student is registered.
DIRECTIONS TO THE STUDENT:
1. Write a half page explanation of why you believe you need to withdraw.
2. Then take the form to your instructors and have them record the last date you attended class and indicate your progress in the course, usually with a letter grade.
DIRECTIONS TO THE INSTRUCTOR:
Please note the student’s current progress in the course (letter grade if possible) and the last date of attendance. If you have questions, please call the Registrar’s Office.
Please return completed form to:
Office of the Registrar
PO Box 1510
Pembroke, NC 28372-1510Office Location: Lumbee Hall, Room 133
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