Revised 7/2019
Office of the Registrar / 200 West Kawili St. Hilo, HI 96720-4091 / Student Services Center, First Floor Rm 101 / Phone: (808) 932-7447 / Fax: (808) 932-7448 / E-mail:
This form must be submitted to the UH Hilo Office of the Registrar by the last day of instruction of the term withdrawing.
This form is to be used when withdrawing from ALL of your UH Hilo classes.
Use STAR GPS for partial and complete withdrawals by the semester deadlines published in the Academic Calendar.
Financial aid may be cancelled or significantly reduced if you withdraw.
Your attendance will be verified with your instructors for Financial Aid purposes.
By completing this form, you understand that you may be required to reapply with Admissions for future registration.
Below are the financial consequences of withdrawing:
*If you withdraw on or before:
You will owe
You will owe
The 2
Classes not on academic record
Tuesday of instruction
0% 0%
The completion of 20% of term
Classes not on academic record
100% 50%
AFTER completion of 20% of term
Classes on academic record with “W
100% 100%
*Deadlines effective Fall 2018
For Summer Session refund dates refer to with CRN.
Information provided here for convenience and does not constitute an official declaration of UH Policy. For official
schedules, please refer to: and
SECTION I: Student Information:
Name: Student ID: ___________________ Phone:_______ _ ___
Email: __________________ Semester: Fall Spring Summer Year: 20_____
Reason, select one only: Academic Difficulty (AD) Dissatisfied with Classes (DS) Employment (EM)
Personal (PR) Financial Issues (FI) Family Responsibilities (FR) Health Problems (HE)
Relocating (RE) Campus Location (LO) Military Duty (MI) No Longer Interested (NI)
Student Signature: __________ Date: ___________________________
SECTION II: Obtain the signature(s) below:
Select Groups:
1. Director, International Student Services _______________________________________________ Date:
Required for International Students on F-1 or J1 visas
2. Graduate Program Chair/Pharmacy Dean______________________________________________ Date:
Required for students in any Graduate Program and in the College of Pharmacy. This excludes Unclassified students.
All Students:
1. Financial Aid _____________________________________________________________________ Date:
Date Received: __________________ Date Posted: ________________ By: __________________ SFAWDRL Official Date:
DD DC WW WE IS Housing Veteran Benefits SHAINST Withdrawal Reason EL Email Student
Last First MI
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