Fillable Student University Withdrawal Request (Florida Polytechnic University)

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Student University Withdrawal Request (Florida Polytechnic University)

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The Student University Withdrawal Request (Florida Polytechnic University) form is 1 page long and contains:

  • 6 signatures
  • 12 check-boxes
  • 31 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Florida Polytechnic University

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REGISTRAR STAFF ONLY
Date Received: _______________
Received By:_________________
Date Processed: ______________
Return to the Office of the University Registrar | IST Room 2052 | 863.874.8540 | registrar@floridapoly.edu
Student University Withdrawal Request
Please complete all required fields in pen and obtain all required prior to submitting form to the Office of the
Registrar. This form is to request a full
withdrawal
from
all university courses you are enrolled in for the current
semester, as defined in
FPU-5.01032AP
Student Withdrawal from the University Policy
.
LAST: _________________________________________ FIRST: ___________________________________ MI: _____
STUDENT ID: ___________________________________ EMAIL: ______________________________@floridapoly.
Step 1: Enter Withdrawal Information
Request to withdraw effective:
Immediately Immediately after the end of the current semester
D
o you plan to return to Florida Poly? Yes No If yes, when? Term: ___________ Year: ___________
A
re you receiving Veteran’s Benefits: Yes No
Do you have a meal plan? Yes No Do reside in on-campus housing? Yes No
Reason for Withdrawal:
Academic Health Financial Relocation Work/Life Conflict
Military Registration Related Transportation Problem/Distance
Transferring to another College/University: If so, where? ____________________________________________
Other: ___________________________________________________________________________________
Step 2: Obtain All Required Signatures (in the order listed below)
Department
Office Personnel
Printed Name
Office Personnel
Signature
D
ate
Signed
Student Development Office
Student Business Services
Academic Success Center
Financial Aid Office
International Student Office
Step 3: Student Confirmation
By signing below, I am confirming my request to be withdrawn from Florida Polytechnic University.
Student’s Signature: _ Date:
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Student University Withdrawal Request (Florida Polytechnic University)

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Completed 15 August 2020

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