Copy to OIRA and Financial Aid
Graduate Withdrawal from the College
Student ID#: Email:
Program of Study:
Are you enrolled in coursework in the current semester YES NO
If YES, will you complete your coursework or withdraw: Complete Withdraw
Effective Date of Withdrawal:
Reason(s) for Withdrawal (check all that apply):
____Transfer (List College):
____Health ____Personal ____Employment ____Military Service
____Financial ____Academic Reasons ____Moving
____Other (please explain):
Student Signature: Date:
International students attending on F-1 Visas must also obtain the signature of the College Primary
Designated School Officer (PDSO).
PDSO Signature: Date:
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