The University of Texas at Tyler
Request to Withdraw Graduation Application
Please Print All Information
Return to Office the Registrar (STE 230)
graduation@uttyler.edu
NAME: _______________________________________________________________________________________
(First) (Middle) (Last)
STUDENT ID NUMBER: _________________________ DATE: _________________________
I wish to withdraw my Graduation Application currently on file for the ______________________________
semester from consideration. I understand that the graduation application access fee will not be refunded,
but will remain on my account to be used towards a future graduation application.
SIGNATURE: ________________________________________
ID Verified: ______ Application Withdrawn: ______ Graduation Tracking Updated: ______
Term Activation Adjusted: ______ Service Indicator Adjusted: ______ MarchingOrder Withdrawn: ______
Notice about Information Laws and Practices
With few exceptions, you are entitled on your request to be informed about the information The University of Texas at Tyler collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to
receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have The University of Texas at Tyler correct information about you that is held by us and that is incorrect, in accordance with
the procedures set forth in The University of Texas System Business Procedures Memorandum 32. The information that The University of Texas at Tyler collects will be retained and maintained as required by Texas records retention
laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time.
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