THE UNIVERSITY OF MICHIGAN-FLINT
OFFICE OF THE REGISTRAR
WITHDRAWAL FORM
PLEASE PRINT
NAME _______________________________ UMID# _______________ MAJOR __________
TERM _______
ADDRESS ________________________________________________________________________________
Street City State Zip Phone
Please check one of the following:
_____ I have attended at least one of my registered classes this term. Last date of attendance _______________
_____ I have not attended any of my registered classes this term.
If you are receiving Financial Aid, you must notify the Financial Aid Office of your
decision before disenrolling.
Would it be useful to discuss your disenrollment with someone in the Academic Advising
Center? YES ____ NO ____
(Graduate student with questions and/or problems, please contact the
Office of Graduate Programs, 221 French Hall or call (810) 762-3171).
For what reason(s) are you leaving? (Please check all that apply)
____ Work Responsibilities ____ Health
____ Personal/Family ____ Housing
____ Financial ____ Dissatisfied with academic progress
____ Dissatisfied w/ policies & ____ Transferring to ________________________
procedures
Do you plan to return to UM-Flint? YES ___ NO ___ If yes, when ____________________
If not, why? __________________________________________________________________
_____________________________________________________________________________
I accept and understand all fees that are associated with this disenrollment.
SIGNATURE _________________________________ DATE ___________________
OFFICE USE ONLY BANNER _____ SA HOLD _____ INITIAL _____
CC: ACADEMIC ADVISING CENTER
FINANCIAL AID
June 2018
I-Drive\Secure Folder\Procedures Manual\Office Procedures\Registrar Forms\Withdrawal Form 2018
