Office of Records and Registration
Resignation Request Form
Name of Student ______________________________ _______________________ __________ W# ________________________
Last First Middle
Email Address ________________________________________ Phone Number _____________________________________
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. http://www.southeastern.edu/recordsandregistration
Email this completed form to firstname.lastname@example.org.
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