Expected Graduation Term
Program
Email
MUID
Section 1: Student Information
Student Instructions
1. If this withdrawal brings you to zero credits, you must complete a Complete Withdrawal Form instead of this form.
2. Complete Sections 1 & 2 of this form using a computer.
a. a handwritten form will not be accepted.
b. an incomplete form will not be processed and returned to you for completion.
3. Print the form using the 'Print Form' button.
4. Sign the form in Section 3; a digital signature is not acceptable.
5. Obtain the required signatures in Section 2 & 4.
6. Submit this form to your college office before the deadline as indicated on the Academic Calendar.
College Office Instructions
Make a determination in Section 5, notify the student and scan the form to the OTR via ImageNow.
Note: tuition refunds will be processed according to the University Withdrawal Schedule
.
Single Course Withdrawal: Health Sciences Professional
Purpose: Used by Health Sciences Professional students to request to withdraw from a single course.
@marquette.edu
Section 2: Course Information
Section 4: Required Signatures
Check and obtain signatures for all that apply
International Student: Signature of Office of International Education
All Students: Signature of Department Chair
Athlete: Signature of Associate Athletic Director for Academic Support
Date
Signature
Section 3: Student statement and signature
I acknowledge that the above information is accurate and that I understand that the withdrawn course will be listed with a withdrawal grade on my transcript. I understand this withdrawal
may affect my degree progress, financial aid, scholarships, veteran's benefits or other areas, such as health insurance and confirm that I have researched these issues and informed the
appropriate coordinator/staff person before taking this action.
Section 5: College Approval
Signature of College Representative Date
Rev. 2/2017
Term/Year
Subject
(e.g. BISC)
Course/Catalog Number
(e.g. 2710)
Section
(e.g. 101)
Instructor
Day/Time Class Meets
Credits
Session
Number of credits remaining after this withdrawal
Name
Last name, First name, Middle name
Withdraw from
Reason for Withdrawal (be clear and concise)
Comments/Exceptions Conditions
Date of last attendance, if status changes (goes from full time to 3/4 time; goes from 1/2 time to less than 1/2 time, etc.)
Denied
Approved
Phone
