Office of Records and Registration
Resignation Request Form
Name of Student ______________________________ _______________________ __________ W# ________________________
Last First Middle
Email Address ________________________________________ Phone Number _____________________________________
Term __________________
I wish to resign my registration for the semester indicated above for the following reason(s):
I understand that my signed resignation request must be received prior to the last day to withdraw for the semester indicated above. If I have
missed the resignation period, I acknowledge that I have a right to appeal my registration depending upon my circumstances and the appeal
policy in place at the time of my appeal and understand that the appeal committee’s decision is final. I also understand that I must contact the
Office of Financial Aid, the Controller’s Office, University Housing, Textbook Rental, and my academic department to ensure there are no
other steps to be taken.
_______________________________________ _______________
Student’s Signature Date
Please refer to the Records and Registration website for more information.
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