Fillable Official Withdrawal Form Registrars Office 222 St. Patrick (The Michener Institute of Education at UHN)

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Official Withdrawal Form Registrars Office 222 St. Patrick (The Michener Institute of Education at UHN)

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Official Withdrawal Form
Registrar’s Office
222 St. Patrick Street Toronto, ON M5T 1V4
regoffice@michener.ca │ 1 (416) 596-3117 or 1 (800) 387-9066
Official Withdrawal Form 1 of 2 23-Jan-2020
Date Received
Office Use Only
*PLEASE PRINT
_______________________________________________________ ___________________________
Name (Last, First, Middle) Student Number
_____________________________________________________________________________________
Address (Number, Street, Unit) City Province Postal Code
________________________________________ ________________________________ _________________________
Telephone Program Name Term
Withdrawal & Refund Schedule
Timeline
Academic
Penalty
Refund
Before the official start of classes up to the end of the 10
th
day of the semester.
None
100% Refund*
From the 11
th
day of the semester to the end of the 20
th
day of the semester.
W Grades
60% Refund*
After the 20
th
day of the semester, but before the end of the 7
th
week of the semester.
W Grades
None
After the 7
th
week of the semester until the last day of classes.
WF Grades
None
After the last day of the semester.
No withdrawal
None
Note: A W grade is a withdrawn status and does not affect Grade Point Average (GPA). A WF grade is a failing grade and will affect GPA.
*less any non-refundable tuition Deposit and non-refundable Ancillary fees, if applicable.
Reason for Withdrawal (Choose one only)
Left to attend another School Obtained Employment Personal/Financial/Medical
Program unsuitable to student Outstanding Fees
Other: ______________________________________________ Last Day of Attendance: __________________________
OSAP (Ontario Student Assistance Program) Funded Students: OSAP will be notified of student withdrawals
and last day of attendance. Withdrawals will affect OSAP entitlements and repayment.
_______________________________________________ _________________________________
Student Signature Date
_____________________________________________________ ____________________________________
Program Chair Signature (Required for withdrawals after Day 10) Date
OFFICE USE ONLY
__________________________________________ ____________________________________
Withdrawal Processed Date RO Initial
IM, PRGM, BB, LR, HS, SSN, ADM Notified Full Withdrawal Reviewed By Registrar or FAO: _____________
Initials
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Official Withdrawal Form Registrars Office 222 St. Patrick (The Michener Institute of Education at UHN)

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Completed 10 February 2021

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