University of Guelph
Ontario Visiting Graduate Student Application
Notification of Withdrawal
Student Name: _______________________ Student ID: __________________________
_______________________ __________________________
_______________________ __________________________
Date of Birth: U of G em
Street Address:
City: Postal Code:
In the event of withdrawal from a course (or courses) at the Host University, the student must complete this form in
duplicate and send:
One copy to the Dean of Graduate Studies at the Host University
One copy to the Dean of Graduate Studies at the University of Guelph
Failure to submit this form prior to the last date for withdrawal from courses published in the Host University
Graduate Calendar may result in a failing grade on the record for the course(s).
Host University and Department: ______________________________________________________________
________ _____
_______________________________________________________________ _________
__________________________ ___________________________
Course Dropped:
Course Title Term Registered
Reason for Withdrawal:
Student Signature:
On receipt of this form the Graduate Dean of the Home University and the Host University is to send copies to the
Department Chair concerned. A grade ofwithdrawn” or similar grade should be reported b the Graduate Dean of
both universities.
Protection of Privacy: We are committed to protecting your privacy. Personal information is collected under the authority of the University of Guelph Act and
pursuant to the Freedom of Information and Protection of Privacy Act (FIPPA). If you have questions about the use and disclosure of your personal information,
call the Office of Graduate Studies at (519) 824-4120 ext. 56833. You can also find more information about access to information and protection of privacy at the
University of Guelph from the University Secretariat.
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