OFFICIAL COLLEGE WITHDRAWAL FORM
For assistance and suggestions to aid you in formulating plans concerning your withdrawal from college, the Wellness Center
is available to serve you, now and in the future. Please consider speaking to a counselor before making a final decision.
Please refer to the College Catalog for the College refund policy. Adjustments to financial aid awards may be necessary as a
result of this withdrawal.
Last Name First Name ID Number
To be considered a withdrawn student in good standing, you must satisfy all obligations to the following offices and
departments. Your college withdrawal is NOT complete until this form is returned to the Registrar’s Office bearing all of the
required signatures. Your official college withdrawal date will be the date this form is returned to the Registrar’s Office.
2. Director of EOP Program (EOP Students only)
4. Student Success Center
5. Residential Life Office/Assistant VP for Student
Student Development and Collegiate Life
8. Student Accounts Office
Perkins Loan Yes No
9. Registrar’s Office:_____________________
Date Signed is Official Date of Withdrawal
I am hereby withdrawing from SUNY Cobleskill.
Student Signature Date