Registrar Received:______________ Scanned/Attached:_________________________ 11.13.20
Manor College Withdrawal from College/Leave of Absence Form
The decision to withdraw from college/take a leave of absence is serious and should be made with a full
understanding of the implication. Each student must contact their Academic Advisor, Financial Aid Office,
Library Director, and the Office of Academic Affairs to review the financial and academic ramifications prior to
withdrawing.
Name: Manor ID Number: A00000
Major: Advisor:
Manor Email Address:
Reason for Withdrawal:
**Students who have an urgent need to discontinue their studies are allowed to have a leave of absence from the College
of
up to one term by submitting this form and being granted approval by the Assistant Dean of Academic Support &
Retention. At the end of the leave of absence period a student may return to the College by being formally readmitted.
The student is still responsible for tuition and fees during a leave of absence.
Last Date of Attendance:
Grade Point Average
Do you plan to return to Manor College? (Yes/No): _______________ If yes, when? ______________________
Withdrawal/Leave of Absence Begins (Midterm/End of Term):__________________________________________
(if you plan on finishing the current term then “End of Term”; if you wish to be withdraw immediately, you will
receive “W” for all ungraded courses and be marked “Midterm Withdraw.”
*************************************************************************************
I acknowledge that I am liable for all unpaid tuition and fees. I acknowledge that any library books, sporting equipment, or loaned
materials must be returned immediately or I will be charged accordingly for those materials. I acknowledge that I have spoken with my
advisor, an officer in Financial Aid, and the Academic Affairs Office to discuss my options to stay at Manor College with a reduced
course load.
By
SIGNING YOUR NAME, you confirm that the information on this form is true, you have read the above terms and
conditions, that you understand them, and that you agree to be bound by them by way of signature. *
STUDENT SIGNATURE: DATE:
Signature below is verified only if this document is being sent through my @manor.edu email account.
Additional Information:__________
