Fillable Program Withdrawal Request- Domestic Students (Durham College Ontario)

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Program Withdrawal Request- Domestic Students (Durham College Ontario)

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The Program Withdrawal Request- Domestic Students (Durham College Ontario) form is 1 page long and contains:

  • 2 signatures
  • 14 check-boxes
  • 17 other fields

Country of origin: CANADA
File type: PDF

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In accordance with the Freedom of Information and Protection of Privacy Act, your personal information is collected, retained and reported to the Ministry of Training, Colleges and Universities under the
legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002. MTCU collects student-level enrolment-related data, which includes limited personal information such as Ontario Education
Numbers, student characteristics and educational outcomes, in order to administer government post-secondary funding, policies and programs, including planning, evaluation and monitoring activities. Your
personal information may also be used or disclosed for administrative, information technology, law enforcement, statistical or research purposes of the College or ministries and agencies of the Ontario and
federal governments. Further details are available at our Privacy page (http://www.durhamcollege.ca/about-us/legal-privacy) or by contacting the Freedom of Information Coordinator, President’s Office,
2000 Simcoe Street North, Oshawa, ON L1H 7K4, 905.721.2000 ext. 3292 September 2019
Program Withdrawal Request- Domestic Students
Strategic Enrolment Services
Oshawa Campus
2000 Simcoe Street North, Oshawa, L1G 0C5
oshawaenrolmentservices@durhamcollege.ca
Tel: 905-721-3000
Whitby
Campus
1610 Champlain Avenue, Whitby, ON L1N 6A7
whitbyenrolmentservices@durhamcollege.ca
Tel: 905-721-3300
If you require an alternate set-up of this form email oshawaenrolmentservices@durhamcollege.ca
If you are registered for one or more courses through CE you must submit a separate withdrawal form to them at coned@durhamcollege.ca
PERSONAL IDENTIFICATION
First name Last name Student ID
Date of birth (mm-dd-yyyy) Phone number Email
Program Last day of attendance (approx.)
This is a mandatory field.
Year of study:
First Second Third
Photo ID card returned:
Yes
No
Did not receive ID card
A $150.00 fee will be
charged/withheld if your
ID card is not returned.
Semester of Study:
1
2
3
4
5
6
1. Domestic Post-secondary students have until the 10
th
day of the semester to withdraw and receive a refund (less $500.00 deposit).
2. Apprenticeship students have until the 1
st
day of classes to withdraw and receive a refund (less $100.00).
REASON FOR WITHDRAWAL
Durham College is commmitted to continuous improvement. To help us understand the needs of students, please indicate your reason(s) for
withdrawal. This information is collected for statistical purposes only.
Academic:
Program does not meet my expectations
Language difficulty
Transfer to other college/university
Academically unprepared
Difficulty adjusting to program demands
Transferring to another program within Durham College
Personal:
Family responsibilities
Health concerns
Career goals changed
Competing priorities for time
Relocating
Financial:
Financial pressure
Insufficient assistance from OSAP
Applied to OSAP but was declined
Tuition/books/supplies too expensive
Other:
Are you considering returning to Durham College?
Yes No
By signing below, I understand that withdrawing from my program may affect current and future OSAP funding. I understand that if I have received
OSAP funding at any time, any potential refund may be returned to NSLSC. Sponsored students may have their refund returned to their sponsor.
Student signature Date submitted
OFFICE USE ONLY
Dean or designate signature
Date
Amount of program incidental
fees to be withheld
$
Refund owing:
$
Date processed
Withdrawal code
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Program Withdrawal Request- Domestic Students (Durham College Ontario)

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Completed 8 February 2021

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