Student Services
40 Avon Street
Keene, NH 03531-3516
Phone: 603-283-2490
Fax: 603-357-7563
Studentservices.ane@antioch.edu
CHANGE of STATUS
Steps:
1. Refer to the AUNE Academic Catalogue (available on the AUNE website) for policy details on program or degree
change, leave of absence or withdrawal including deadlines, fees, refunds and impacts on financial aid.
2. Provide all the requested information.
3. Obtain Faculty Advisor and/or Program Director signatures as needed. Sign and date the form.
4. Submit form to Student Services. (Keep a copy for your records.)
Today’s Date: ________________________ Name: _____________________________________________________________
Address: ___________________________________________________________________________________________________
Is this mailing address a change of information?
r
No
r
Yes (If yes, please update your address in AUVIEW).
Student ID: __________________________ Antioch Email Address: _______________________________________________
Program: ____________________ Current Enrollment Status:
r
Part-Time
r
Full-Time
Completion of this section means that a degree will not be conferred for the program in which you are currently enrolled
and registration is not adjusted.
1. Indicate term & year of intended program or degree change: r Spring 20_____ r Summer 20_____ r Fall_____
2. Program/Code From: ______________________ Faculty Advisor Signature & Date:_________________________________
3. Program/Code To: ________________________ Faculty Advisor Signature & Date:_________________________________
Student must still register for each term of LOA.
Student in capstone phase, on continuation or with INC/INP from prior terms may not take LOA.
1. Please explain the reason for your request for a LOA:
2. Indicate term & year of requested LOA: r Spring 20_____ r Summer 20_____ r Fall_____
3. Program Director Signature:_____________________________________________________ Date:______________________
Complete this section only if you wish to withdraw permanently from the University.
To request a leave of 1- 3 terms, complete the Leave of Absence section above.
1. I wish to withdraw from the University: r Effectively immediately. r At the end of this term. I plan to complete my courses.
2. What is your reason for withdrawal (check all that apply):
r Academic r Financial r Health r Military r Transferring to: ____________________________________
r Other__________________________________________________________________________________________
3. I have spoken with my Program Director or Faculty Advisor and am aware of all of my options: r Yes r No
Student Signature: _________________________________________________________________ Date: ____________________
Forms must be submitted at least 30 days prior to the first term of program addition. Students may be held responsible for financial
implications of retroactive processing. Students are responsible for checking the Academic Catalogue for policy details.
Revised 9.05.18
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
