Vancouver Learning Network
530 East 41st Avenue Vancouver, BC V5W 1P3
s.ca Tel: (604) 713-5520
Course Withdrawal Request Form
Personal Education Number (PEN: 9 digit
Legal First Name:_______________________________
Legal Last Name:_______________________________
Legal Middle Name (If you do not have one put NONE):______________________
Preferred First Name:____________________________
Course Name: ___________________________________
Course Section: ________________________________
Reason for withdrawing (Select from dropdown):
Is there anything that we can do to help you finish the course instead of withdrawing?
For paper-based courses please return all course materials as soon as possible after withdrawing from the course.
Any deposits on paper-based courses will be refunded once we receive your course materials and deposit receipt.
Select withrawal reason from list below: