Office of the Registrar
–
Clarion University of Pennsylvania 07/2020
Semester/University Withdrawal Form
The deadline for withdrawing
from ALL classes for the CURRENT TERM is the last day of classes prior to the beginning of finals week. Please
indicate the correct effective term of withdrawal whether you are withdrawing from the current term or a future term. The effective date of
withdrawal is determined by the date the form is submitted to the Registrar's Office. University withdrawals will not be processed retroactively.
Fall (15 Weeks) Fall 7 Week 1
Winter
Name ___________________________________________
Clarion ID _____________________________________________
Email
_______________________________
_______
Effective Term(s) of Withdrawal (please check box below and indicate year): Year _________
Summer 1 (3 weeks) Summer 2 (5 weeks) Summer 3 (5 weeks) Summer 7 Week 1 Summer 7 Week 2
Location: Clarion Venango Pittsburgh
Online Off-Site/Other
Reason for Withdrawal (please check one) If your withdrawal is related to COVID-19, you need to contact Financial Aid.
Financial Personal Academic
Insufficient/No Aid Death in the Family Suspension
Cost of Attendance Family Obligation Major not Offered
Unexpected Expenses Roommate Conflict Did not have Courses
Medical* Interpersonal/Social Conflict Scheduling Problems
Health* Medical Child Care Courses too Difficult
Accident* Could not find housing Inadequate Advising
Stress/Emotional* Inadequate Facilities Conflict with Faculty/Staff
Totally & Permanently Disabled* Inadequate Transportation
Relocating Inadequate Handicapped Facilities
Church Missionary
Service with a Foreign Aid Service
Employment Other________________________________ of the Federal Government
Need Part-time/Summer work Military*
Transfer/Reason: ________________________________________________________ * Documentation is required
Is there someone within a particular area of the university with whom you would like to speak prior to completing the withdrawal process?
Office, Area or Name of Person (if known)
Do you plan to return to Clarion? Yes No
term/year reason
I affirm that I have considered and understand the effects of this withdrawal.
Student Signature _____________________________________________________________ Date _____________________________
(It is your responsibility to verify the form has been processed in your online student account.
Office Use Only
Effective Date of Withdrawal: ___________________________________ Processed by: _____________
(The effective date of withdrawal will be the date we receive the written
intention to withdraw in the Registrar's Office)
Withdrawal Instructions
1. Students must type directly on this form or print legibly.
2. Fill in all information
completely including Clarion ID number.
3. Return form to
Registrar's Office.
Venango Campus
Venango Administration
200 Frame Hall
Clarion University Main Campus
148 Becht Hall
840 Wood Street
Clarion PA 16214
Fax: 814-393-2039
registrar@clarion.edu
Pittsburgh Site Room 334
4. Please contact the Financial Aid Office (814-393-2315) for an
analysis of how your withdrawal will affect your
financial aid.
Check that you have considered the following before deciding to withdraw:
Financial Aid/Scholarships
Athletic eligibility
Veterans benefits
On-campus student employment
How this change may impact graduation
Other items this withdrawal
might impact
Health insurance benefits
Housing (If you are in university housing, you must sign a contract release form)
The forms are available in 218 Becht or online at
http://clarion.edu/student-life/living-at-clarion/campus-housing/
index.html The forms are listed under
Contract Release Forms
.
Spring (15 week) Spring 7 Week 1 Spring 7 Week 2
Fall 7 Week 2
