RESIGNATION CARD – Louisiana Tech University
INSTRUCTIONS: PLEASE FOLLOW IN THIS ORDER.
1. UNIVERSITY REGISTRAR: Check to see if ROTC and Chemistry
Lab clearances are needed. If so, obtain signatures.
_________________ ROTC Supply _____________Chem. Lab
2. REPORT TO ACADEMIC DEAN. Obtain signature of dean or
authorized representative.
3. CHECK OUT OF RESIDENCE HALL, if applicable. Obtain “check-
out” slip from residence hall staff.
4. REPORT TO HOUSING OFFICE. Bring “check-out” slip to obtain
“move-out” slip and signature of Director of Housing.
5. REPORT TO OFFICE OF FOOD SERVICE (Tolliver Cafeteria).
Obtain signature on “move-out” slip and surrender ID card.
6. OBTAIN signature from Financial Aid (KH 240) even though you
received no aid.
7. REPORT TO CASHIER’S WINDOW (Comptroller’s Office) to
present “move-out” slip and obtain signature of Comptroller, KH
103.
8. REPORT TO UNIVERSITY REGISTRAR. Sign and turn in
Resignation Card, KH 207.
NOTE: Students should check with Library, University Police, and
Bookstore for outstanding books and fines. If any charges are left
outstanding, all transcripts and future registrations will be withheld.
This Resignation is not official until filed in the Office of the
Registrar.
SS#__________/________/___________
________________________________________________________
Last Name First Middle
is Resigned/ Unenrolled/ Suspended from Louisiana Tech
University the ______________ of _____________________20____
Day Month
for the following reason:
________________________________________________________
_________________________ ___________________________
Academic Dean Financial Aid
_________________________ ___________________________
Director of Housing Comptroller (Cashier’s Window)
_________________________ ___________________________
Food Service & I.D. Student’s Signature
Students who have applied for federal financial aid must have the following section completed. Fed
financial aid includes Pell Grant, SEOG, LEAP, Perkins Loan, Stafford Loan, or PLUS Loan.
Course Section Last attended (date) Never attended (init) Instructor’s signature
Student: Provide an address where you can be reached in the future. Phone ( )_____________-____________________
Street___________________________________________________City____________________State_______Zip__________
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