Domestic Withdrawal Form
Important Notes: Revision Date: May 2020
It is recommended that students see their Program Coordinator or a Counsellor before withdrawing from the College. This form is to
be submitted to the Registrar’s Office along with the student’s Clinical ID card (if applicable). It is the student’s responsibility to notify
Sutherland Residence Village or Frost Residence of their withdrawal. Parking passes must be returned to either the Information Kiosk at
Sutherland Campus or the Cashier’s Office at Frost Campus. If a student withdraws after the 10
th
day of scheduled classes, a refund will
not be issued for the semester.
Last Name: ___________________ First Name: _____________________ Student Number: ___________
Email Address: _____________________________ Preferred Phone Number: ______________________ Program: ________________________
Street Address: ______________________________________________________________ ___________ Semester: ________________________
City:________________________________________ Province: __________ Postal: ______________ Campus: ________________________
Reason for Withdrawal: Financial Health Obtained Employment Personal Transferring to another College Progression
Covid-19 Other __________________________________________________________________
Date of Withdrawal: Effective Immediately Effective End of Term
* I have discussed my withdrawal with my Academic Coordinator prior to submitting this request
Student Signature: ____________________________________________________________ Date: _____________________________________
This Section to be completed only if an OSAP Student
Please include any income you have received from the first day of classes to the date of withdrawal.
A. Total gross income from Government benefits (excludes GST, Child Tax Benefit, OSAP or Universal Child Tax Benefit) $________________
Type of Government Income: __________________________________________________
B. Total gross income from scholarships, bursaries and awards: $________________
C. Total gross income from all other sources (including employment income): $________________
The amount of OSAP you were eligible to receive will be recalculated based on the time that you were attending up until the actual withdrawal date. In
most situations, you will have received more OSAP funding than you were entitled to receive. Any overpayment on your OSAP acc ount will be deducted
from future loans you receive (for this academic year) or you will be required to repay the overpaid amount. Any tuition fee refund that you are eligible
to receive will be directed to the National Student Loan Service Centre to pay down your loan and overpayment on your OSAP ac count file.
I hereby declare that the information provided on this form is true and accurate to the best of my knowledge.
Student Signature: _____________________________________________________________ Date: ________________________________________
Office Use Date Stamp
Records Use Only:
Effective Date of Withdrawal: ___________________
Amount Paid: $ _____________
Deductions:
Administrative Fee: $ _____________
Other: $_____________
Total Owing: $_____________
Refund: $ _____________
Signature: ____________________________ Date: _________________
Financial Aid use only:
Effective Date of Withdrawal: ___________________
Tuition Fee Adjustment $ ____________________
Compulsory Fees: $_____________________
Books: $_____________________
Signature: __________________ Date: ________
NSLSC: Yes No
Mgr Signature: ______________ Date: ________
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
click to sign
signature
click to edit
INSTRUCTIONS:
Complete, sign and return the withdrawal form to the Registrars Office:
Mail: Registrar’s Office or Registrar’s Office
Sutherland Campus Frost Campus
599 Brealey Drive 200 Albert Street
Peterborough, ON Lindsay, ON
K9J 7B1 K9V 5E6
Scan & Email: records@flemingcollege.ca (for all campus withdrawals)
Fax: Sutherland Campus Frost Campus
705-749-5507 705-878-9331
The effective date of the withdrawal is the date the properly completed form is received by the Registrars Office.
COLLEGE WITHDRAWAL POLICY:
Students officially withdrawing from the College by the final date for registration in a semester will have all courses deleted from their student record
for the semester. Students officially withdrawing from the College after the final date for registration for that semester and before the final third of the
semester will have the designation Withdrew (W) recorded against that semester's courses. Students who officially withdraw fr om the college during
the final third of the semester will have the designation Withdrew Failing (WF) recorded on their permanent academic record. Students are to ensure
that they are familiar with the Academic Schedule for specific withdrawal dates and the Academic Regulations with respect to the complete College
Withdrawal Policy.
Full-time Domestic Postsecondary Students
In accordance with the Ministry of Training, College and Universities binding directive on Tuition and Ancillary Fees,
Students who submit formal written notification of withdrawal to the Registrars Office, within 10 business days of the beginning of the semester are
entitled to a refund of tuition and ancillary fees as follows:
1. Students who submit a formal notification of withdrawal from a full -time program of instruction within 10 days of the beginning of the semester
or the beginning of the period for which the student paid fees, are entitled to a refund of the full tuition and ancillary fees for the semester or
program period less $250.00, and a refund in full of any tuition and ancillary fees paid in advance for subsequent semesters.
2. Students who formally withdraw after the 10
th
day of the semester will receive a refund of tuition and ancillary fees paid in advance for
subsequent terms only. Any refunds will first be credited to fee s outstanding ie) residence, optional fees or outstanding tuition fees from previous
semesters. For students receiving OSAP funding, refunds will first be payable to the National Student Loan Services Centre for credit against
existing loans as per Section N - Student Declaration of the OSAP Application for Full-time Students. Any remaining refund balance will be made
payable to the student.
3. After 10 business days students are entitled to a refund in full of any fees paid in advance for subsequent semesters only. Any outstanding fees
for the current semester are due to the college.
Note: Non-attendance does not constitute an official withdrawal.
Part-Time Students
Students officially withdrawing by the 10th day of the current semester will be refunded for:
a. all semester tuition and ancillary fees assessed and paid, less $25 per course administrative fee and any incidental admin istrative charges
b. or all Installment Plan fees assessed and paid, less any related incidental administrative fees
c. and all fees paid in advance for subsequent semesters
Note: Outstanding fees for the semester from which the student has officially withdrawn are due to the College. Any refunds will first be credited to
fees outstanding i.e. residence, optional fees or outstanding tuition fees from previous semesters. Service charges are non-refundable (includes
installment, late and deferral charges.)
OSAP Eligible Students
Any refund, regardless of origin of payment, for which the student may be eligible will be payable to the National Student Loan Service Centre for credit
against existing loans.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome