OSU Student ID
Last Name First Middle/Maiden
Term Year
I request permission to officially withdraw from the university for the term.
Student Signature Today's Date
Authorized Signature Today's Date
TERM WITHDRAWAL FORM
Please forward a copy of the form to the Office of the University Registrar, registrar@osu.edu
The reason(s) for this request is:
College Academic Level Campus
Effective Date of the Withdrawal as determined by the College Office _____/_____/_____
If the effective withdrawal date has been backdated, is your office able to provide supporting documentation (by
request) for audit purposes? ___ Yes ___No
Rev 02/2018
Name.#
Based on Faculty Rule 3335-8-32 (Withdrawal from Courses or from the university), this form is used to officially withdraw
from the university for the term. If after the 7
th
Friday (for Quarters) or 10th Friday (for Semesters), students must petition
with the enrollment unit for approval to withdraw due to circumstances beyond their control. If the petition is approved, the
mark "W" will be recorded on the student's academic record for each course involved. A lack of preparation or dissatisfaction
with the course is not an acceptable reason to withdraw after the 7
th
Friday (for Quarters) or 10th Friday (for Semesters).
-
COLLEGE OFFICE USE ONLY
Authorized Signer’s Name (Print Please)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Is this withdrawal request past the 7
th
Friday (Quarters) or 10th Friday (semesters)? ____ Yes ____No
If yes, has the student completed the petition process and been approved? ____ Yes ____No
O.U.R. USE ONLY
OUR Processed Date _____/_____/_____ Processor’s Initials ______________________________
Last Date of Attendance (Military Use) _____/_____/_____
